Active NPI
Melissa Ann Jorgenson, PTA
- Physical Therapy Assistant
- Ipswich, SD
National Provider Identifier
1376737585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 0232
- Practice address
- 617 Bloemendaal Dr
Ipswich, SD 57451-2019 - Phone
- (605) 426-6622
- NPI assigned
- Aug 30, 2007
- 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 | 0232 | SD | Primary |
Addresses
Primary practice location
617 Bloemendaal Dr
Ipswich, SD 57451-2019
Mailing address
617 Bloemendaal Dr
Ipswich, SD 57451-2019
Phone (605) 426-6622
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 |
|---|---|---|---|
| 0232 | SD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188432000000",
"number": "1376737585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "617 BLOEMENDAAL DR",
"city": "IPSWICH",
"state": "SD",
"postal_code": "574512019",
"telephone_number": "605-426-6622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617 BLOEMENDAAL DR",
"city": "IPSWICH",
"state": "SD",
"postal_code": "574512019",
"telephone_number": "605-426-6622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORGENSON",
"first_name": "MELISSA",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-08-30",
"last_updated": "2007-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "SD",
"license": "0232",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ipswich, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.