NPIMap

Organization Active NPI

Fitness Focus, Inc.

Doing business as Fitness Focus

  • Physical Therapy Clinic/Center
  • Mahtomedi, MN
National Provider Identifier
1720156680
Registry record updated Sep 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
4723 Issued in MN
Legal business name
FITNESS FOCUS, INC.
Doing business as
Fitness Focus
Practice address
688 Wildwood Road
Mahtomedi, MN 55115-2060
Phone
(651) 429-9947
Fax
(651) 429-1029
NPI assigned
Nov 30, 2006
Last updated
Sep 26, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2022

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

Authorized official

Name
Mrs. Shannon Dee Maixner, PTNPI 1861583379
Title
Owner - Physical Therapist
Phone
(651) 429-9947

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 4723 MN Primary

Addresses

Primary practice location

688 Wildwood Road
Mahtomedi, MN 55115-2060

Mailing address

688 Wildwood Road
Mahtomedi, MN 55115-2060
Phone (651) 429-9947

Other names 1

  • Fitness Focus Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111024000101 MN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3577736396 Receives reassigned benefits from 7 practitioners
Practice locations: Mahtomedi, MN

National Provider Directory

National Provider Directory

Locations

688 Wildwood Rd
Saint Paul, MN 55115
Phone (651) 429-9947

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664150400000",
    "number": "1720156680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "688 WILDWOOD ROAD",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551152060",
            "telephone_number": "651-429-9947",
            "fax_number": "651-429-1029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "688 WILDWOOD ROAD",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551152060",
            "telephone_number": "651-429-9947",
            "fax_number": "651-429-1029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FITNESS FOCUS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A",
        "authorized_official_last_name": "MAIXNER",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "DEE",
        "authorized_official_title_or_position": "OWNER - PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "651-429-9947",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MN",
            "license": "4723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fitness Focus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mahtomedi, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.