Individual provider Active NPI

Nicole Rae Ruotsinoja, PTA

  • Physical Therapy Assistant
  • Forest Lake, MN
National Provider Identifier
1750489175
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
Practice address
967 S Lake St
Forest Lake, MN 55025
Phone
(651) 464-1113
Fax
(651) 464-0853
NPI assigned
Sep 20, 2006
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 Therapy Assistant 225200000X Primary

Addresses

Primary practice location

967 S Lake St
Forest Lake, MN 55025

Mailing address

967 S Lake St
Forest Lake, MN 55025
Phone (651) 464-1113

Other identifiers 1

IdentifierTypeStateIssuer
282PIGOOtherMNBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750489175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "967 S LAKE ST",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "55025",
            "telephone_number": "651-464-1113",
            "fax_number": "651-464-0853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "967 S LAKE ST",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "55025",
            "telephone_number": "651-464-1113",
            "fax_number": "651-464-0853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUOTSINOJA",
        "first_name": "NICOLE",
        "middle_name": "RAE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "282PIGO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Lake, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.