Active NPI
Jessica Mikacevich, PT
- Physical Therapist
- Burnsville, MN
National Provider Identifier
1669728838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 9098
- Practice address
- 172 Cobblestone LN
Burnsville, MN 55337-4578 - Phone
- (763) 201-8191
- NPI assigned
- Jul 25, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9098 | MN | Primary |
Addresses
Primary practice location
172 Cobblestone LN
Burnsville, MN 55337-4578
Mailing address
9645 Grove Cir N Ste 200
Maple Grove, MN 55369-2684
Phone (763) 201-8191
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9098 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620864000000",
"number": "1669728838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9645 GROVE CIR N STE 200",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553692684",
"telephone_number": "763-201-8191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "172 COBBLESTONE LN",
"city": "BURNSVILLE",
"state": "MN",
"postal_code": "553374578",
"telephone_number": "763-201-8191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKACEVICH",
"first_name": "JESSICA",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-25",
"last_updated": "2021-05-13",
"certification_date": "2021-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "9098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burnsville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.