Active NPI
Melanie Daggy, PTA
- Physical Therapy Assistant
- South Bend, IN
National Provider Identifier
1023628005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- Practice address
- 53880 Carmichael Dr
South Bend, IN 46635-1567 - Phone
- (574) 247-1572
- Fax
- (574) 247-9442
- NPI assigned
- Aug 5, 2020
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | Primary |
Addresses
Primary practice location
53880 Carmichael Dr
South Bend, IN 46635-1567
Mailing address
53880 Carmichael Dr
South Bend, IN 46635-1567
Phone (574) 247-1572
Other practice location 1
60160 Bodnar Blvd
Mishawaka, IN 46544-9338
Phone (574) 247-2790
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06003493A | Other | IN | LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | sbortho.com |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596585600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596585600000",
"number": "1023628005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "53880 CARMICHAEL DR",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351567",
"telephone_number": "574-247-1572",
"fax_number": "574-247-9442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "53880 CARMICHAEL DR",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351567",
"telephone_number": "574-247-1572",
"fax_number": "574-247-9442"
}
],
"practiceLocations": [
{
"address_1": "60160 Bodnar Blvd",
"address_purpose": "LOCATION",
"city": "Mishawaka",
"state": "IN",
"postal_code": "465449338",
"country_code": "US",
"telephone_number": "574-247-2790",
"fax_number": "574-247-9442",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DAGGY",
"first_name": "MELANIE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-05",
"last_updated": "2020-08-05",
"certification_date": "2020-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "06003493A",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "sbortho.com",
"affiliation": "N",
"endpointDescription": "Web site",
"address_1": "53880 Carmichael Dr",
"city": "South Bend",
"state": "IN",
"country_code": "US",
"postal_code": "466351567",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.