Individual provider Active NPI

Marjorie Keely Mowbray, MSPT

  • Pediatric Physical Therapist
  • Hanover, PA
National Provider Identifier
1518056803
Registry record updated Nov 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
PT015709 Issued in PA
Practice address
36 Sara LN
Hanover, PA 17331-8670
Phone
(717) 372-8748
Fax
(717) 646-9995
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X PT015709 PA Primary

Addresses

Primary practice location

36 Sara LN
Hanover, PA 17331-8670

Mailing address

36 Sara LN
Hanover, PA 17331-8670
Phone (717) 372-8748

Other identifiers 1

IdentifierTypeStateIssuer
1009347620003OtherPAMA PROMISE PROVIDER#

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
PT015709PAMDPediatric Physical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478736000000",
    "number": "1518056803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 SARA LN",
            "city": "HANOVER",
            "state": "PA",
            "postal_code": "173318670",
            "telephone_number": "717-372-8748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 SARA LN",
            "city": "HANOVER",
            "state": "PA",
            "postal_code": "173318670",
            "telephone_number": "717-372-8748",
            "fax_number": "717-646-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOWBRAY",
        "first_name": "MARJORIE",
        "middle_name": "KEELY",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2016-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "PA",
            "license": "PT015709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MA PROMISE PROVIDER#",
            "identifier": "1009347620003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hanover, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2016; 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.