Active NPI
Susan M Jewett, DPT
- Physical Therapist
- Deer River, MN
National Provider Identifier
1851991566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11984
- Practice address
- 115 10TH Ave NE
Deer River, MN 56636-8795 - Phone
- (218) 246-2900
- NPI assigned
- Oct 30, 2020
- Last updated
- Oct 30, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 15260 | WI | |
| Physical Therapist | 225100000X | 11984 | MN | Primary |
Addresses
Primary practice location
115 10TH Ave NE
Deer River, MN 56636-8795
Mailing address
1702 University Dr S
Fargo, ND 58103-4940
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 |
|---|---|---|---|
| 11984 | MN | MD | Physical Therapist |
| 15260 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604016000000",
"number": "1851991566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1702 UNIVERSITY DR S",
"city": "FARGO",
"state": "ND",
"postal_code": "581034940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 10TH AVE NE",
"city": "DEER RIVER",
"state": "MN",
"postal_code": "566368795",
"telephone_number": "218-246-2900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEWETT",
"first_name": "SUSAN",
"middle_name": "M",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-30",
"last_updated": "2020-10-30",
"certification_date": "2020-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "15260",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "11984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deer River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.