Active NPI
Desiree Ann Mata, PT
- Physical Therapist
- Grants Pass, OR
National Provider Identifier
1235598392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 06567
- Practice address
- 1710 NE Fairview Ave
Grants Pass, OR 97526-3877 - Phone
- (541) 479-2606
- NPI assigned
- Feb 17, 2016
- Last updated
- Feb 17, 2016
- 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 | 06567 | OR | Primary |
Addresses
Primary practice location
1710 NE Fairview Ave
Grants Pass, OR 97526-3877
Mailing address
406 NE Silverwood PL
Grants Pass, OR 97526-2226
Phone (541) 450-2496
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 |
|---|---|---|---|
| 06567 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455667200000",
"number": "1235598392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 NE SILVERWOOD PL",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975262226",
"telephone_number": "541-450-2496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1710 NE FAIRVIEW AVE",
"city": "GRANTS PASS",
"state": "OR",
"postal_code": "975263877",
"telephone_number": "541-479-2606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATA",
"first_name": "DESIREE",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-02-17",
"last_updated": "2016-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "06567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grants Pass, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.