Active NPI
Diane C Hendrickson, PT
- Physical Therapist
- Stillwater, MN
National Provider Identifier
1912016189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1197
- Practice address
- 1460 Curve Crest Blvd W
Stillwater, MN 55082-6070 - Phone
- (651) 439-8283
- Fax
- (651) 439-0576
- NPI assigned
- Aug 30, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1197 | MN | Primary |
Addresses
Primary practice location
1460 Curve Crest Blvd W
Stillwater, MN 55082-6070
Mailing address
1460 Curve Crest Blvd W
Stillwater, MN 55082-6070
Phone (651) 439-8283
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 912S9HE | Other | MN | BCBS-MINNESOTA |
| HP47697 | Other | MN | HEALTHPARTNERS |
| 64-05177 | Other | MN | MEDICA |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912016189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1460 CURVE CREST BLVD W",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550826070",
"telephone_number": "651-439-8283",
"fax_number": "651-439-0576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1460 CURVE CREST BLVD W",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550826070",
"telephone_number": "651-439-8283",
"fax_number": "651-439-0576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDRICKSON",
"first_name": "DIANE",
"middle_name": "C",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "1197",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS-MINNESOTA",
"identifier": "912S9HE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP47697",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "64-05177",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Stillwater, 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.