Integrated Motion Pediatric Physical Therapy, Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5428 Issued in MN

Legal business name

INTEGRATED MOTION PEDIATRIC PHYSICAL THERAPY, INC.

Practice address

4660 Slater Rd
Suite #130
Eagan, MN 55122-4047

Phone

(651) 260-3774

Fax

(651) 688-6389

NPI assigned

Nov 29, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Sara Stutsman Massaro, PTNPI 1255408712

Title

President

Phone

(651) 260-3774

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sara Stutsman Massaro, PT

  • Physical Therapist
  • Eagan, MN
  • NPI 1255408712
  NPD (past) Authorized official

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942377411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4540 OAK CHASE LN",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551232804",
            "telephone_number": "651-260-3774",
            "fax_number": "651-688-6389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4660 SLATER RD",
            "address_2": "SUITE #130",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551224047",
            "telephone_number": "651-260-3774",
            "fax_number": "651-688-6389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED MOTION PEDIATRIC PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MASSARO",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "STUTSMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-260-3774",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "5428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Eagan, MN
• Providers in Eagan, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.

Verify at the official NPI Registry.