Individual provider Active NPI

Susan Aleta Cleaveland, P.T.

  • Physical Therapist
  • St Louis Park, MN
National Provider Identifier
1689741670
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1907 Issued in MN
Practice address
6490 Excelsior Blvd
St Louis Park, MN 55426-4705
Phone
(952) 993-3559
NPI assigned
Nov 29, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1907 MN Primary

Addresses

Primary practice location

6490 Excelsior Blvd
St Louis Park, MN 55426-4705

Mailing address

6465 Wayzata Blvd
Ste 315
St Louis Park, MN 55426-1728

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080121000082 MN Practitioner - Physical Therapist in Private Practice 5991886509 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

3931 Louisiana Ave S
St Louis Park, MN 55426-5000
Phone (952) 993-3123

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1907MNMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Jan 1, 2007 Accepting new patients
Tria Orthopaedic Center LLC Physical Therapist CurrentSince Feb 1, 2021 Accepting new patients
Park Nicollet Clinic CurrentSince Jan 1, 2007 Accepting new patients
Tria Orthopaedic Center LLC Physical Therapist CurrentSince Feb 1, 2021 Accepting new patients
Park Nicollet Clinic Current Accepting new patients

Locations

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626

6490 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 925-2888

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689741670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD",
            "address_2": "STE 315",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6490 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264705",
            "telephone_number": "952-993-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEAVELAND",
        "first_name": "SUSAN",
        "middle_name": "ALETA",
        "name_prefix": "Ms.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "1907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.