Amy Magnuson, DPT
Individual provider Active NPI Physical Therapist · Luck, WI
NPI 1922486307 · NPPES record last updated Aug 14, 2024
Key facts
- NPI
- 1922486307
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 10068 (MN)
- Practice address
- 2547 Wi-35 Ste #5
Luck, WI 54853 - Phone
- (715) 472-5225
- NPI assigned
- May 18, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230503001180 | WI | Practitioner - Physical Therapist in Private Practice | 6305201922 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16135-24 | WI | MD | Physical Therapist |
| 4038 | MN | MD | Nurse Practitioner |
| 10068 | MN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amery Regional Medical Center, Inc. | Current |
Accepting new patients | |
| Amery Regional Medical Center, Inc. | Current |
Accepting new patients |
Locations
265 Griffin St E
Amery, WI 54001
Phone (715) 268-0301
2547 State Hwy 35
Ste 5
Luck, WI 54853
Phone (715) 472-5225
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 16135-24 | WI | |
| Student in an Organized Health Care Education/Training Program | 390200000X | 4038 | MN | |
| Physical Therapist | 225100000X | 10068 | MN | Yes |
Addresses
Primary practice location
2547 Wi-35 Ste #5
Luck, WI 54853
Mailing address
5366 386TH St NE
North Branch, MN 55056-5833
Phone (651) 674-6775
Other providers in Luck, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.