Active NPI
Sadie Alane Mattingly, PTA/L
- Physical Therapy Assistant
- Kingman, AZ
National Provider Identifier
1306308572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A03508
- Practice address
- 3131 Western Ave
Kingman, AZ 86401-0951 - Phone
- (928) 718-0718
- NPI assigned
- Apr 4, 2019
- 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 Therapy Assistant | 225200000X | A03508 | KY | Primary |
Addresses
Primary practice location
3131 Western Ave
Kingman, AZ 86401-0951
Mailing address
1933 Windsor Ave
Owensboro, KY 42301-4454
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 |
|---|---|---|---|
| A03508 | KY | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554336000000",
"number": "1306308572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1933 WINDSOR AVE",
"city": "OWENSBORO",
"state": "KY",
"postal_code": "423014454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3131 WESTERN AVE",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "864010951",
"telephone_number": "928-718-0718"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTINGLY",
"first_name": "SADIE",
"middle_name": "ALANE",
"credential": "PTA/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-04",
"last_updated": "2019-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "KY",
"license": "A03508",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingman, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.