Active NPI
Nicole M Lavanty, MSPT
- Physical Therapist
- Minneapolis, MN
National Provider Identifier
1851373609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 7672
- Practice address
- 715 S 8TH St FL 3
Minneapolis, MN 55404-7530 - Phone
- (612) 873-4524
- Fax
- (612) 873-1608
- NPI assigned
- Nov 17, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 7672 | MN | Primary |
Addresses
Primary practice location
715 S 8TH St FL 3
Minneapolis, MN 55404-7530
Mailing address
6515 Barrie Rd
Suite 100
Edina, MN 55435-2305
Phone (952) 922-5019
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7672 | MN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medford Sports Injury & Therapy Center, Inc. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Medford, OR
- NPI 1932279916
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731974400000",
"number": "1851373609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6515 BARRIE RD",
"address_2": "SUITE 100",
"city": "EDINA",
"state": "MN",
"postal_code": "554352305",
"telephone_number": "952-922-5019",
"fax_number": "952-922-1384"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 S 8TH ST FL 3",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554047530",
"telephone_number": "612-873-4524",
"fax_number": "612-873-1608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAVANTY",
"first_name": "NICOLE",
"middle_name": "M",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-17",
"last_updated": "2024-11-19",
"certification_date": "2024-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "7672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.