Shannon Maixner, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4723 Issued in MN

Practice address

688 Wildwood Rd
Mahtomedi, MN 55115-1812

Phone

(651) 429-9947

NPI assigned

Sep 28, 2006

Sex

Female

Sole proprietor

No

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.

• Fitness Focus, Inc.

  • Physical Therapy Clinic/Center
  • Mahtomedi, MN
  • NPI 1720156680

  MN, Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official

Specialty

Physical Therapist in Private Practice

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fitness Focus, Inc. 6 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in MN

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 11, 2024.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1861583379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "688 WILDWOOD RD",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551151812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "688 WILDWOOD RD",
            "city": "MAHTOMEDI",
            "state": "MN",
            "postal_code": "551151812",
            "telephone_number": "651-429-9947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAIXNER",
        "first_name": "SHANNON",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "4723",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Avery Grace Macintosh
• Mahtomedi Dental Clinic
• Mahtomedi Dental Clinic
• Mahtomedi Family Dental
• Mahtomedi Natural Care Center
• Kaitlyn Matteson, MA, LADC
• Sara Elaine McGrath, MS-CCC, SLP
• Aria Elizabeth Mullin, LMFT
• Gina Christine Nelson, DC
• New Perspective Mahtomedi

• All providers in Mahtomedi, MN
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.