Active NPI
Conner Simons, DPT
- Physical Therapist
- Minneapolis, MN
National Provider Identifier
1942859079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11691
- Practice address
- 2112 Broadway St NE Ste 195
Minneapolis, MN 55413-3093 - Phone
- (612) 767-9917
- Fax
- (612) 767-9918
- NPI assigned
- Sep 11, 2019
- Last updated
- May 28, 2024
- 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 | 11691 | MN | Primary |
Addresses
Primary practice location
2112 Broadway St NE Ste 195
Minneapolis, MN 55413-3093
Mailing address
1939 Minnehaha Ave W Ste 300
Saint Paul, MN 55104-1033
Phone (651) 748-4338
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190926000679 | MN | Practitioner - Physical Therapist in Private Practice | 9638409139 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716854400000",
"number": "1942859079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1939 MINNEHAHA AVE W STE 300",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551041033",
"telephone_number": "651-748-4338",
"fax_number": "651-748-2892"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2112 BROADWAY ST NE STE 195",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554133093",
"telephone_number": "612-767-9917",
"fax_number": "612-767-9918"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIMONS",
"first_name": "CONNER",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-11",
"last_updated": "2024-05-28",
"certification_date": "2024-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "11691",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.