Vanessa L Mavrode, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA02187800 Issued in NJ

Practice address

755 Memorial Pkwy Ste 208
Phillipsburg, NJ 08865-2773

Phone

(908) 847-6756

NPI assigned

Sep 13, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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.

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1407633449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CONOVER TER",
            "city": "LEBANON",
            "state": "NJ",
            "postal_code": "088332183",
            "telephone_number": "908-391-3619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 MEMORIAL PKWY STE 208",
            "city": "PHILLIPSBURG",
            "state": "NJ",
            "postal_code": "088652773",
            "telephone_number": "908-847-6756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVRODE",
        "first_name": "VANESSA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-13",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02187800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matlock Chiropractic LLC
• John Anthony Matlock, D.C.
• Rebecca Marie Matlock, D.C.
• James W Mattison Jr., D.C.
• Danielle Maurice, PT, DPT
• Jill M McCormick, M.S., R.D., L.D.N.
• Maureen McCoy, BA
• William Steven McEwen, RPH
• Thomas McGinley, M.D.
• Daria Malinchak McPhee, MS, ACSW, LCSW

• Physical Therapist in Phillipsburg, NJ
• Providers in Phillipsburg, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; 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.