Individual provider Active NPI

Becky Olson-Kellogg, P.T.

  • Physical Therapist
  • Edina, MN
National Provider Identifier
1902819774
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5101 Issued in MN
Practice address
3400 W 66TH St
Suite 140
Edina, MN 55435-2111
Phone
(952) 345-3000
NPI assigned
Aug 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5101 MN Primary

Addresses

Primary practice location

3400 W 66TH St
Suite 140
Edina, MN 55435-2111

Mailing address

2820 Aquila Ave S
St Louis Park, MN 55426-2952

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

LicenseStateTypeSpecialty
5101MNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
National Dizzy & Balance Center,LTD. Physical Therapist PastSince May 1, 2006 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.

NPI Registry JSON

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902819774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 AQUILA AVE S",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554262952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 W 66TH ST",
            "address_2": "SUITE 140",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352111",
            "telephone_number": "952-345-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON-KELLOGG",
        "first_name": "BECKY",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "5101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.