Active NPI
Mary Ann Daugherty, RPT
- Physical Therapist
- Jefferson City, MO
National Provider Identifier
1043450109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 02034
- Practice address
- 1030 Edmonds St
Jefferson City, MO 65109-5213 - Phone
- (615) 896-6400
- NPI assigned
- Mar 3, 2009
- 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 Therapist | 225100000X | 02034 | MO | Primary |
Addresses
Primary practice location
1030 Edmonds St
Jefferson City, MO 65109-5213
Mailing address
310 Smoky Mountain CT
Columbia, MO 65203-8001
Phone (615) 896-6400
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02034 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236038400000",
"number": "1043450109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 SMOKY MOUNTAIN CT",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652038001",
"telephone_number": "615-896-6400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 EDMONDS ST",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651095213",
"telephone_number": "615-896-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAUGHERTY",
"first_name": "MARY",
"middle_name": "ANN",
"credential": "RPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-03",
"last_updated": "2009-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "02034",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.