Mallory Lynn Damon, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1403411 Issued in KS

Practice address

510 W 7TH St
Ellinwood, KS 67526-1101

Phone

(629) 564-2337

NPI assigned

Nov 25, 2019

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 25, 2019.

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1376189233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 S WASHINGTON AVE",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675309657",
            "telephone_number": "620-639-1819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 W 7TH ST",
            "city": "ELLINWOOD",
            "state": "KS",
            "postal_code": "675261101",
            "telephone_number": "629-564-2337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAMON",
        "first_name": "MALLORY",
        "middle_name": "LYNN",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-25",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "KS",
            "license": "1403411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Advanced Practice Specialties, LLC
• Christopher M Brown, MD
• City of Ellinwood
• Stacy Lynn Clawson, PTA
• Dan Leroy Davis, DDS
• Diversicare of Ellinwood, LLC
• Robin D Durrett, DO
• Ellinwood Public Schools Usd 355
• Ellinwood Senior Living

• All providers in Ellinwood, KS
• Physical Therapy Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.

Verify at the official NPI Registry.