Active NPI
Deanna Marie Nordwald, PTA
- Physical Therapy Assistant
- Mexico, MO
National Provider Identifier
1336572908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2013026824
- Practice address
- 711 E Jackson St
Mexico, MO 65265-2903 - Phone
- (573) 582-8888
- Fax
- (573) 582-3774
- NPI assigned
- Aug 18, 2013
- Last updated
- Aug 18, 2013
- 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 | 2013026824 | MO | Primary |
Addresses
Primary practice location
711 E Jackson St
Mexico, MO 65265-2903
Mailing address
7627 Audrain Road 355
Mexico, MO 65265-5804
Phone (573) 721-3308
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 |
|---|---|---|---|
| 2013026824 | MO | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376784000000",
"number": "1336572908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7627 AUDRAIN ROAD 355",
"city": "MEXICO",
"state": "MO",
"postal_code": "652655804",
"telephone_number": "573-721-3308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 E JACKSON ST",
"city": "MEXICO",
"state": "MO",
"postal_code": "652652903",
"telephone_number": "573-582-8888",
"fax_number": "573-582-3774"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NORDWALD",
"first_name": "DEANNA",
"middle_name": "MARIE",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-18",
"last_updated": "2013-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MO",
"license": "2013026824",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mexico, MO
- Noble Health Audrain Inc (Audrain Com Clinic Family Med)
- Noble Health Audrain Inc (Audrain Urgent Care Clinic)
- Noble Health Audrain Inc (Audrain Comm Womens Health)
- Noble Health Audrain Inc (Audrain Comm Clinic)
- Noble Health Audrain Inc (Platinum Health Systems Audrain)
- James R Northern, DO
- Sarah Ogar, DPT
- Stephanie A Owings
- David Earl Oxford, M.D.
- Paige Duenke, D.C., LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.