Active NPI
Larry Jon Mengelkoch, PH.D, P.T.
- Physical Therapist
- Gainesville, FL
National Provider Identifier
1528259082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 4560
- Practice address
- 5715 NW 67TH CT
Gainesville, FL 32653-3208 - Phone
- (352) 505-3509
- Fax
- (352) 505-3509
- NPI assigned
- Aug 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 4560 | FL | Primary |
Addresses
Primary practice location
5715 NW 67TH CT
Gainesville, FL 32653-3208
Mailing address
5715 NW 67TH CT
Gainesville, FL 32653-3208
Phone (352) 505-3509
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 4560 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186531200000",
"number": "1528259082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5715 NW 67TH CT",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326533208",
"telephone_number": "352-505-3509",
"fax_number": "352-505-3509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5715 NW 67TH CT",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326533208",
"telephone_number": "352-505-3509",
"fax_number": "352-505-3509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENGELKOCH",
"first_name": "LARRY",
"middle_name": "JON",
"name_prefix": "Dr.",
"credential": "PH.D, P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-08",
"last_updated": "2007-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT 4560",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.