Impact Physical Medicine

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

105096 Issued in MN

Legal business name

IMPACT PHYSICAL MEDICINE

Practice address

1600 University Ave W Ste 10
Saint Paul, MN 55104-3898

Phone

(651) 646-7246

Fax

(651) 641-0726

NPI assigned

May 20, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Cynthia Jane Mueller, M.A.

Title

Occupational Therapist

Phone

(612) 250-2995

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Courtland Agre, MD

  • Physical Medicine & Rehabilitation Physician
  • Bloomington, MN
  • NPI 1902919723
  NPD
• Christie Jane Thames Amundson, PT, DPT, PRC, HFS

  • Physical Therapist
  • Saint Paul, MN
  • NPI 1467643429
  NPD
• Gary Clay Meyer

  • Massage Therapist
  • Saint Paul, MN
  • NPI 1316659154
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463702400000",
    "number": "1689021586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 UNIVERSITY AVE W STE 10",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043898",
            "telephone_number": "651-646-7246",
            "fax_number": "651-641-0726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 UNIVERSITY AVE W STE 10",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043898",
            "telephone_number": "651-646-7246",
            "fax_number": "651-641-0726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT PHYSICAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-20",
        "last_updated": "2016-05-20",
        "status": "A",
        "authorized_official_last_name": "MUELLER",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST",
        "authorized_official_telephone_number": "612-250-2995",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "105096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Margaret Imhoff, MA-CCC
• Katherine Louise Imm, RN
• Immaculate Home Care LLC
• Abigail R Immerfall, PT, DPT
• Immigrant Women and Children Development Center
• Impact Physical Medicine and Aquatic Center
• Impact Physical Medicine of St. Paul
• In Charge Home Healthcare Service
• In Home Personal Care, Inc.
• In Tandem Counseling, Inc

• Clinic/Center in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.