Individual provider Active NPI

Susan E Walts, PT

  • Physical Therapist
  • Plymouth, MN
National Provider Identifier
1962479501
Registry record updated Aug 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
7419 Issued in MN
Practice address
14100 Carlson Pkwy Ste 200
Plymouth, MN 55441-5312
Phone
(763) 519-7900
Fax
(763) 450-0202
NPI assigned
Mar 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2024

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 7419 MN Primary

Addresses

Primary practice location

14100 Carlson Pkwy Ste 200
Plymouth, MN 55441-5312

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 IDStateProvider typePAC IDDetails
I20090507000301 MN Practitioner - Physical Therapist in Private Practice 3779631460 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Therapy Partners IncGroup PAC ID 4486552593, 135 clinicians

Practice addresses (Care Compare)

14100 Carlson Pkwy
Suite 200
Plymouth, MN 55441-5312
Phone (763) 519-7900

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6575GAMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services CurrentSince May 23, 2010 Accepting new patients
Fairview Health Services CurrentSince May 23, 2010 Accepting new patients
Fairview Express Care CurrentSince Mar 1, 2020 Accepting new patients
Fairview Express Care CurrentSince Mar 1, 2020 Accepting new patients
Therapy Partners Inc Physical Therapist CurrentSince Oct 1, 2024 Accepting new patients
Therapy Partners, Inc. Physical Therapist CurrentSince Oct 1, 2024 Accepting new patients
Fairview Express Care Current Accepting new patients
Fairview Health Services Current Accepting new patients
Atlanta Rehabilitation and Performance Center PastSince Jun 16, 2003 Accepting new patients
Atlanta Rehabilitation and Performance Center Past Accepting new patients

Locations

15650 Cedar Ave
Ste 160
Apple Valley, MN 55124
Phone (952) 997-4170

14101 Fairview Dr
Ste 300
Burnsville, MN 55337
Phone (612) 273-5400

701 25th Ave S
Ste 500
Minneapolis, MN 55454
Phone (612) 313-8831

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

14100 Carlson Pkwy
Ste 200
Plymouth, MN 55441
Phone (763) 519-7900

1939 Minnehaha Ave W
Ste 300
Saint Paul, MN 55104

1700 Tower Dr W
Stillwater, MN 55082
Phone (651) 275-4706

Organizations & group practices 10

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

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1962479501",
    "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": "14100 CARLSON PKWY STE 200",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554415312",
            "telephone_number": "763-519-7900",
            "fax_number": "763-450-0202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTS",
        "first_name": "SUSAN",
        "middle_name": "E",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-02",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "7419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; 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.