Active NPI
Brian Maldonado
- Physical Therapist
- Minneapolis, MN
National Provider Identifier
1679004535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6593
- Practice address
- 1091 16TH Ave SE Apt 1
Minneapolis, MN 55414-2411 - Phone
- (612) 378-3022
- NPI assigned
- Mar 22, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 | 6593 | MN | Primary |
Addresses
Primary practice location
1091 16TH Ave SE Apt 1
Minneapolis, MN 55414-2411
Mailing address
1091 16TH Ave SE Apt 1
Minneapolis, MN 55414-2411
Phone (612) 378-3022
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490140800000",
"number": "1679004535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1091 16TH AVE SE APT 1",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554142411",
"telephone_number": "612-378-3022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1091 16TH AVE SE APT 1",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554142411",
"telephone_number": "612-378-3022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALDONADO",
"first_name": "BRIAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-22",
"last_updated": "2017-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "6593",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.