Mildred Margaret Vandergon, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1001 Issued in AK

Practice address

12103 Horseshoe Dr
Suite B
Eagle River, AK 99577-7547

Phone

(907) 696-3657

Fax

(907) 622-3657

NPI assigned

Nov 16, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Meg Vandergon Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• United Physical Therapy, LLC

  • Physical Therapist
  • Anchorage, AK
  • NPI 1609888130
  NPD
• Mind, Body, Soul

  dba Mind, Body, Soul Physical Therapy

  • Physical Therapist
  • Eagle River, AK
  • NPI 1780960229
  NPD (past)

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

{
    "created_epoch": "1353024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353024000000",
    "number": "1144564949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10620 LONE TREE DR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995076924",
            "telephone_number": "907-346-4509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12103 HORSESHOE DR",
            "address_2": "SUITE B",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777547",
            "telephone_number": "907-696-3657",
            "fax_number": "907-622-3657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERGON",
        "first_name": "MILDRED",
        "middle_name": "MARGARET",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-16",
        "last_updated": "2012-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AK",
            "license": "1001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MEG",
            "last_name": "VANDERGON",
            "credential": "PT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Eric M Unruh, LCSW
• Daniel Upton, CC
• Vacca Physiatry LLC
• Brian Domenic Vacca, MD
• Vanessa Van Cleve
• Lixue Burney Vanucci, OTD, OTR/L, LSVT-BIG
• Vision Therapy Center Inc.
• Michael Joseph Vogel, PSY.D.
• Amanda Vogus, LMT
• Volunteers of America Alaska

• Physical Therapist in Eagle River, AK
• Providers in Eagle River, AK by specialty
• Physical Therapist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.