STACEY MIRON (NPI# 1205365707) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205365707 |
| Entity Type | Individual |
| Full Name | STACEY MIRON |
| Other Name | STACEY GLAESS |
| Practice Address |
5200 Fairview Blvd Wyoming MN 55092-8013 |
| Mailing Address |
15250 Homestead Ave N Hugo MN 55038-9408 |
| Practice Telephone | 6519827000 |
| Mailing Telephone | 6129409064 |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2017-08-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225100000X | Physical Therapist | 10660 | MN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MINNESOTA BOARD OF PHYSICAL THERAPY | 10660 | 01 |
| Street Address |
5200 FAIRVIEW BLVD |
| City | WYOMING |
| State | MN |
| Zip Code | 55092-8013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528061371 | Gunnar Jon Erickson | Ophthalmology | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2005-05-24 |
| 1902414378 | Fairview Express Care | General Practice | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2020-07-21 |
| 1023648235 | Cassandra L Etheridge | Physician Assistant | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2020-01-16 |
| 1023652211 | Natasha Lackas | Speech-Language Pathologist | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2019-10-31 |
| 1467019414 | Terrence Ellis | Clinical Exercise Physiologist | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2019-05-24 |
| 1790341493 | Krystal Kraemer | Dietitian, Registered | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2019-05-17 |
| 1225509037 | Lauren Downie | Dietitian, Registered | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2018-12-06 |
| 1861977787 | Magdalen Rene Gadbois | Speech-Language Pathologist | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2018-09-26 |
| 1285110338 | Marie Hudalla | Physical Therapist | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2018-07-12 |
| 1023502697 | Molly Levy | Nurse Practitioner | 5200 Fairview Blvd, Wyoming, MN 55092 | 2018-06-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821696022 | Wyoming Family Dental | Dentist | 5378 East Viking Blvd., Wyoming, MN 55092 | 2020-10-12 |
| 1851909436 | Matthew Rohlf | Dentist | 5378 E Viking Blvd, Wyoming, MN 55092 | 2020-07-20 |
| 1669013280 | Christina Marie Orde | Technician | 4855 261st Street, Wyoming, MN 55092 | 2019-10-04 |
| 1609425966 | Faith Bouttell | Technician | 25423 Heims Lake Circle, Wyoming, MN 55092 | 2019-09-10 |
| 1275875031 | Fairview Express Care | Clinic/Center | 5130 Fairview Blvd, Suite 101, Wyoming, MN 55092 | 2013-03-20 |
| 1023385242 | St. Croix Orthopaedics, P.a. | Durable Medical Equipment & Medical Supplies | 5200 Fairview Blvd., Wyoming, MN 55092 | 2011-11-17 |
| 1902851876 | Tamara Piroska Petrac-halatsis | Obstetrics & Gynecology | 5200 Fairview Boulevard, Ob/gyn Department, Wyoming, MN 55092 | 2006-05-22 |
| 1376922070 | Carli Lynn Ceder | Physical Therapist | 5130 Fairview Blvd, Wyoming, MN 55092 | 2015-05-27 |
| 1396087433 | Fairview Health Services | Durable Medical Equipment & Medical Supplies | 5130 Fairview Blvd, Suite 104, Wyoming, MN 55092 | 2013-03-26 |
| 1598007726 | Fairview Health Services | Prosthetic/Orthotic Supplier | 5130 Fairview Blvd, Suite 103, Wyoming, MN 55092 | 2013-03-26 |
| Find all providers in zip 55092 | ||||
| Taxonomy Code | 225100000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT’s assess joint motion, muscle strength and endurance, function of heart and lungs, and performance of activities required in daily living, among other responsibilities. Treatment includes therapeutic exercises, cardiovascular endurance training, and training in activities of daily living. (2) A physical therapist is a person qualified by an accredited program in physical therapy, licensed by the state, and practicing within the scope of that license. Physical therapists treat disease, injury, or loss of a bodily part by physical means, such as the application of light, heat, cold, water, electricity, massage and exercise. They develop treatment plans based upon each patient’s strengths, weaknesses, range of motion and ability to function. (3) A health professional who specializes in physical therapy- the health care field concerned primarily with the treatment of disorders with physical agents and methods, such as massage, manipulation, therapeutic exercises, cold, heat (including short-wave, microwave, and ultrasonic diathermy), hydrotherapy, electric stimulation and light to assist in rehabilitating patients and in restoring normal function after an illness or injury. |
| Notes: Source: (1) APTA Guidelines for Physical Therapy Claims Review, American Physical Therapy Association. (3) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588203947 | Benjamin R Eggleston | Physical Therapist | 1736 Gezon Pkwy Sw Ste 100, Wyoming, MI 49519-9525 | 2020-01-03 |
| 1306491741 | Rene Thomas | Physical Therapist | 118 Springfield Pike, Wyoming, OH 45215-4230 | 2019-08-02 |
| 1215430699 | Jennifer Anne-gluszewski Patterson | Physical Therapist | 6105 Wilson Ave, Wyoming, MI 49426 | 2018-03-13 |
| 1639625601 | Nicole L Elders | Physical Therapist | 5570 Wilson Ave Sw Ste A, Wyoming, MI 49418-8867 | 2016-08-30 |
| 1598143117 | Kristina Muscat | Physical Therapist | 5653 Barcroft Dr Sw, Wyoming, MI 49418-9312 | 2015-05-14 |
| 1285022376 | Hollie Dimare | Physical Therapist | 170 2nd St, Wyoming, PA 18644-2115 | 2014-12-26 |
| 1972904761 | Carmen Vandyke | Physical Therapist | 3040 Waterchase Way Sw, Apt 302, Wyoming, MI 49519-5990 | 2014-09-11 |
| 1477990786 | Barbara Campbell | Physical Therapist | 551 36th St Se, Wyoming, MI 49548-2355 | 2013-05-28 |
| 1972850279 | Angela Demetria Onyekanne | Physical Therapist | 123 Springfield Pike, Wyoming, OH 45215-4263 | 2012-08-07 |
| 1295095214 | Prakash Pasupathy | Physical Therapist | 5825 Powderhorn Ct Sw, Wyoming, MI 49418-9340 | 2012-05-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.