Jacqueline M Anderson, DPT

Key facts

NPI

1891005757

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

8641 (MN)

Practice address

300 Coon Rapids Blvd NW
Coon Rapids, MN 55433-5643

Phone

(763) 767-0854

NPI assigned

Oct 13, 2010

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 13, 2010.

{
    "created_epoch": "1286928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286928000000",
    "number": "1891005757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335643",
            "telephone_number": "763-767-0854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335643",
            "telephone_number": "763-767-0854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JACQUELINE",
        "middle_name": "M",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-13",
        "last_updated": "2010-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "8641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

• Nicole R Amundson, DDS
• Kimberly Anne An, AU.D.
• Gina Lorraine Andersland, DDS
• Allison Keiko Anderson
• Gregg W. Anderson, M.D.
• Melanie A Anderson, PT
• Sherri L Anderson, CMT
• Thomas Warren Anderson, DDS
• Jennifer Andrews
• Mackenzie Andropolis, PA-C, MPH

All providers in Coon Rapids, MN · Physical Therapist in Minnesota