Individual provider Active NPI

Monica E Messmer-Tunnell, PT

  • Pediatric Physical Therapist
  • Broken Arrow, OK
National Provider Identifier
1477550101
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
2077 Issued in OK
Practice address
2608 W Kenosha St # 496
Broken Arrow, OK 74012-8952
Phone
(918) 284-4220
Fax
(918) 249-2817
NPI assigned
Jul 7, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 2077 OK
Pediatric Physical Therapist 2251P0200X 2077 OK Primary

Addresses

Primary practice location

2608 W Kenosha St # 496
Broken Arrow, OK 74012-8952

Mailing address

2608 W Kenosha St # 496
Broken Arrow, OK 74012-8952
Phone (918) 284-4220

Other identifiers 2

IdentifierTypeStateIssuer
02710OtherOKBLUE CROSS BLUE SHIELD
100665910CMedicaidOK

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

LicenseStateTypeSpecialty
2077OKMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Joyful Heart Pediatric Therapy, PLLC Pediatrics Current Accepting new patients

Locations

2608 W Kenosha St
Broken Arrow, OK 74012
Phone (918) 259-0001

Organizations & group practices 1

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1477550101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2608 W KENOSHA ST # 496",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740128952",
            "telephone_number": "918-284-4220",
            "fax_number": "918-249-2817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 W KENOSHA ST # 496",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740128952",
            "telephone_number": "918-284-4220",
            "fax_number": "918-249-2817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MESSMER-TUNNELL",
        "first_name": "MONICA",
        "middle_name": "E",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "OK",
            "license": "2077",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "OK",
            "license": "2077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "02710",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100665910C",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Broken Arrow, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2020; 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.