Fitness Focus, Inc.
Organization Active NPI Physical Therapy Clinic/Center · Mahtomedi, MN
NPI 1720156680 · NPPES record last updated Sep 26, 2022
Key facts
- NPI
- 1720156680
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- License
- 4723 (MN)
- Legal business name
- FITNESS FOCUS, INC.
- Practice address
- 688 Wildwood Road
Mahtomedi, MN 55115-2060 - Phone
- (651) 429-9947
- Fax
- (651) 429-1029
- NPI assigned
- Nov 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Shannon Dee Maixner, PT
- Title
- Owner - Physical Therapist
- Phone
- (651) 429-9947
Practitioners 10
-
Shannon Maixner, PT
-
Kaci Ann Carroll, DPT
-
Hannah Huerta, PT,DPT
-
Ryan Zachary Lee, PT
-
Matthew Mychal Zellmer, PT, DPT, ATR, CSCS
-
Ann Alexander, PT, DPT, LAT, CSCS
-
Kelly Lynne Roberts, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
688 Wildwood Rd
Saint Paul, MN 55115
Phone (651) 429-9947
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | 4723 | MN | Yes |
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
- Fitness Focus
Other providers in Mahtomedi, MN
- Caley Erban
- Jeannie Marie Farrell
- Olivia Fesser
- Andrea Finch
- Virginia Fitch-Braun
- Noel Fredericksen
- Lisa Giuliani
- Golden Roots Therapy, LLC
- Bradley John Hagen
- Steven Hagstrom
All providers in Mahtomedi, MN · Physical Therapy Clinic/Center in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.