Active NPI
Susan Pon, LPT
- Physical Therapist
- Springfield, MO
National Provider Identifier
1376614917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 01376
- Practice address
- 1545 E Pythian St
Springfield, MO 65802-2139 - Phone
- (417) 829-0893
- Fax
- (417) 831-7539
- NPI assigned
- Nov 13, 2006
- 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 | 01376 | MO | Primary |
Addresses
Primary practice location
1545 E Pythian St
Springfield, MO 65802-2139
Mailing address
1545 E Pythian St
Springfield, MO 65802-2139
Phone (417) 829-0893
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 |
|---|---|---|---|
| 01376 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1376614917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1545 E PYTHIAN ST",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658022139",
"telephone_number": "417-829-0893",
"fax_number": "417-831-7539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1545 E PYTHIAN ST",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658022139",
"telephone_number": "417-829-0893",
"fax_number": "417-831-7539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PON",
"first_name": "SUSAN",
"credential": "LPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "01376",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.