Individual provider Active NPI

Patrick Michielutti, DPT

  • Physical Therapist
  • Lakeville, MN
National Provider Identifier
1922557107
Registry record updated Sep 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
18425 Dodd Blvd
Lakeville, MN 55044-9019
Phone
(952) 985-8800
NPI assigned
Sep 28, 2016
Last updated
Sep 28, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2016

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 NU Primary

Addresses

Primary practice location

18425 Dodd Blvd
Lakeville, MN 55044-9019

Mailing address

18425 Dodd Blvd
Lakeville, MN 55044-9019

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170303000243 MN Practitioner - Physical Therapist in Private Practice 0547544959 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tria Orthopaedic Center LLCGroup PAC ID 3173570561, 504 clinicians

Practice addresses (Care Compare)

155 Radio Dr
Woodbury, MN 55125-2619
Phone (952) 831-8742

8100 Northland Dr
Bloomington, MN 55431-4800
Phone (952) 831-8742

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Life Clinic, P.a. Physical Therapist CurrentSince Nov 4, 2016 Accepting new patients
Tria Orthopaedic Center LLC Physical Therapist CurrentSince Nov 18, 2019 Accepting new patients

Locations

18425 Dodd Blvd
Lakeville, MN 55044
Phone (952) 232-1330

8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626

33 Hamline Ave S
Saint Paul, MN 55105
Phone (612) 868-6894

155 Radio Dr
Woodbury, MN 55125
Phone (952) 883-6212

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1475020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475020800000",
    "number": "1922557107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18425 DODD BLVD",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18425 DODD BLVD",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550449019",
            "telephone_number": "952-985-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHIELUTTI",
        "first_name": "PATRICK",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-28",
        "last_updated": "2016-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; 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.