NPIMap

Organization Active NPI

Active Therapy MN

  • Physical Therapist
  • Eden Prairie, MN
National Provider Identifier
1730835257
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ACTIVE THERAPY MN
Practice address
10300 Hennepin Town Rd
Eden Prairie, MN 55347-5100
Phone
(612) 562-8204
Fax
(763) 328-0111
NPI assigned
Feb 23, 2022
Last updated
Mar 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2022

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

Authorized official

Name
Sheldon Hollander
Title
Managing Member
Phone
(612) 562-8204

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Occupational Therapist 225X00000X
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

10300 Hennepin Town Rd
Eden Prairie, MN 55347-5100

Mailing address

6633 N Lincoln Ave
Lincolnwood, IL 60712-3605
Phone (612) 562-8204

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220413000866 MN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2769878099 Receives reassigned benefits from 27 practitioners
Practice locations: Coon Rapids, MN; Saint Paul, MN; Golden Valley, MN; Elk River, MN; Eden Prairie, MN; Maplewood, MN

National Provider Directory

National Provider Directory

Locations

80 S 8th St
Minneapolis, MN 55402

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1645574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1730835257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6633 N LINCOLN AVE",
            "city": "LINCOLNWOOD",
            "state": "IL",
            "postal_code": "607123605",
            "telephone_number": "612-562-8204",
            "fax_number": "763-328-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10300 HENNEPIN TOWN RD",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553475100",
            "telephone_number": "612-562-8204",
            "fax_number": "763-328-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE THERAPY MN",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-23",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "HOLLANDER",
        "authorized_official_first_name": "SHELDON",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "612-562-8204"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 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.