Mardi Eden Mangus, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT38833 Issued in FL

Practice address

708 3Rd St N
Jacksonville Beach, FL 32250-7149

Phone

(904) 822-4622

NPI assigned

Jul 20, 2022

Last updated

Jul 20, 2022By the provider in NPPES

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1658275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1144955584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 RUNAWAY CIR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320821255",
            "telephone_number": "716-860-8021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 3RD ST N",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322507149",
            "telephone_number": "904-822-4622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGUS",
        "first_name": "MARDI",
        "middle_name": "EDEN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-20",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT38833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA DEPARTMENT OF HEALTH",
            "identifier": "PT38833",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; 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.