Active NPI
Kathy Elaine Maxey, PT, ATC
- Sports Physical Therapist
- Columbia, MO
National Provider Identifier
1003025446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physical Therapist
- License
- 01865
- Practice address
- 1100 Club Village Dr
Suite 103
Columbia, MO 65203-4409 - Phone
- (573) 256-2777
- Fax
- (573) 256-2764
- NPI assigned
- May 22, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Sports Physical Therapist | 2251S0007X | 01865 | MO | Primary |
Addresses
Primary practice location
1100 Club Village Dr
Suite 103
Columbia, MO 65203-4409
Mailing address
2308 Kyle Dr
Columbia, MO 65203-5705
Phone (573) 445-0595
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 |
|---|---|---|---|
| 01865 | MO | MD | Sports Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BDM Associates LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Columbia, MO
- NPI 1801847033
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003025446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2308 KYLE DR",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652035705",
"telephone_number": "573-445-0595",
"fax_number": "573-256-2764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 CLUB VILLAGE DR",
"address_2": "SUITE 103",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652034409",
"telephone_number": "573-256-2777",
"fax_number": "573-256-2764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAXEY",
"first_name": "KATHY",
"middle_name": "ELAINE",
"credential": "PT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": "MO",
"license": "01865",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.