Pamela Michelle Macon, MPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

112634 Issued in MO

Practice address

11365 Dorsett Rd
Maryland Heights, MO 63043-3411

Phone

(314) 872-6440

NPI assigned

Feb 20, 2007

Sex

Female

Sole proprietor

Yes

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": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467597153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 IRENE CT",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631314141",
            "telephone_number": "314-568-7822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11365 DORSETT RD",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630433411",
            "telephone_number": "314-872-6440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACON",
        "first_name": "PAMELA",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "MPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "MO",
            "license": "112634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Liu, PHARMD
• Living Well Consumer Directed Services, LLC
• Alma Katigbak Lopez, OTR
• Leonard G Lucas, DO
• Mac RX of Missouri, LLC
• Magellan Health Services
• Magellan Healthcare, Inc.
• Constance Mann, MSW, LCSW
• Katherine Lee Marshall, NP
• Larry Marshall, MA,LPC

• Pediatric Physical Therapist in Maryland Heights, MO
• Providers in Maryland Heights, MO by specialty
• Pediatric Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.