Active NPI
Mary H Peter, LPTA
- Physical Therapy Assistant
- Fayetteville, AR
National Provider Identifier
1215184676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA 1737
- Practice address
- 2474 E Joyce Blvd
Ste, 2
Fayetteville, AR 72703-4519 - Phone
- (479) 521-8326
- NPI assigned
- Aug 27, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | PTA 1737 | AR | Primary |
Addresses
Primary practice location
2474 E Joyce Blvd
Ste, 2
Fayetteville, AR 72703-4519
Mailing address
2474 E Joyce Blvd
Ste, 2
Fayetteville, AR 72703-4519
Phone (479) 521-8326
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTA 1737 | Other | AR | STATE LICENSE |
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 |
|---|---|---|---|
| PTA 1737 | AR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219795200000",
"number": "1215184676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2474 E JOYCE BLVD",
"address_2": "STE, 2",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727034519",
"telephone_number": "479-521-8326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2474 E JOYCE BLVD",
"address_2": "STE, 2",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727034519",
"telephone_number": "479-521-8326"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETER",
"first_name": "MARY",
"middle_name": "H",
"credential": "LPTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-27",
"last_updated": "2008-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AR",
"license": "PTA 1737",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "PTA 1737",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.