Gray Duck Physical Therapy PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

GRAY DUCK PHYSICAL THERAPY PLLC

Practice address

299 Coon Rapids Blvd NW Ste 103
Coon Rapids, MN 55433-5869

Phone

(612) 217-2154

Fax

(612) 447-0159

NPI assigned

May 21, 2021

Organization subpart

No

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

Authorized official

Name

Nicholas J Manning, DPT

Title

Owner

Phone

(612) 217-2154

Specialties & licenses 1

Addresses

Other names 1

• Gray Duck Physical Therapy Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Philip Punnoose, PT

  • Physical Therapist
  • Eden Prairie, MN
  • NPI 1801523782
  NPD (past)

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635724800000",
    "number": "1861067068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "299 COON RAPIDS BLVD NW STE 103",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335869",
            "telephone_number": "612-217-2154",
            "fax_number": "612-447-0159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 COON RAPIDS BLVD NW STE 103",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335869",
            "telephone_number": "612-217-2154",
            "fax_number": "612-447-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAY DUCK PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-21",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A",
        "authorized_official_last_name": "MANNING",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-217-2154",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gray Duck Physical Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Gray Duck Physical Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Joseph L Graif, M.D.
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• Kelley Graves, APRN
• Alphonoso Gray
• Lauren Ann Greely
• Green Lakes LLC
• Joseph Lynn Green, D.O.
• Zoe Green

• Physical Therapist in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; 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.