NPIMap

Individual provider Active NPI

Michael Tupas Laguitao, P.T.

  • Physical Therapist
  • Waynesville, MO
National Provider Identifier
1437345360
Registry record updated Sep 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
02189 Issued in MO
Practice address
2107 Historic Rte. 66 West
Apt. #2
Waynesville, MO 65583-2442
Phone
(573) 774-4125
NPI assigned
Sep 25, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 02189 MO Primary

Addresses

Primary practice location

2107 Historic Rte. 66 West
Apt. #2
Waynesville, MO 65583-2442

Mailing address

2107 Historic Rte. 66 West
Apt. #2
Waynesville, MO 65583-2442
Phone (573) 774-4125

Other identifiers 3

IdentifierTypeStateIssuer
PT11828OtherFLPT LICENSE
02189OtherMOMO. PT LICENSE
05003954AOtherINPT LICENSE

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ma. Teresa Sison Enciso PT. PC. Corp Physical Therapist CurrentSince Oct 1, 2011 Accepting new patients
Medicom, Inc Past Accepting new patients
Waynesville Physical Therapy Past Accepting new patients
Reagan Rehabilitation Outpatient Therapy, LLC Physical Therapist PastSince Feb 14, 2016 Accepting new patients

Locations

124 Ichord Ave
Waynesville, MO 65583
Phone (573) 774-3684

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190678400000",
    "number": "1437345360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2107 HISTORIC RTE. 66 WEST",
            "address_2": "APT. #2",
            "city": "WAYNESVILLE",
            "state": "MO",
            "postal_code": "655832442",
            "telephone_number": "573-774-4125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2107 HISTORIC RTE. 66 WEST",
            "address_2": "APT. #2",
            "city": "WAYNESVILLE",
            "state": "MO",
            "postal_code": "655832442",
            "telephone_number": "573-774-4125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAGUITAO",
        "first_name": "MICHAEL",
        "middle_name": "TUPAS",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-25",
        "last_updated": "2007-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "02189",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "PT11828",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MO. PT LICENSE",
            "identifier": "02189",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "05003954A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waynesville, MO

Sources for this page

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

Verify at the official NPI Registry.