Active NPI
Marcus Donal Fahey, PT
- Physical Therapist
- Buffalo, MN
National Provider Identifier
1932204898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 7030
- Practice address
- 101 14TH St NE Ste a
Buffalo, MN 55313-2966 - Phone
- (763) 684-3880
- NPI assigned
- Sep 14, 2006
- Last updated
- Jan 2, 2020
- Sex
- Male
- 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 | 7030 | MN | Primary |
Addresses
Primary practice location
101 14TH St NE Ste a
Buffalo, MN 55313-2966
Mailing address
PO Box 1005
Annandale, MN 55302-1005
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
| License | State | Type | Specialty |
|---|---|---|---|
| 7030 | MN | MD | Audiologist |
Interoperability endpoints
- mfahey323395@excellian.direct.allina.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577923200000",
"number": "1932204898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1005",
"city": "ANNANDALE",
"state": "MN",
"postal_code": "553021005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 14TH ST NE STE A",
"city": "BUFFALO",
"state": "MN",
"postal_code": "553132966",
"telephone_number": "763-684-3880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAHEY",
"first_name": "MARCUS",
"middle_name": "DONAL",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2020-01-02",
"certification_date": "2020-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "7030",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.