NPIMap

Organization Active NPI

Mellevore, LLC

Doing business as Mathis Physical Therapy

  • Physical Therapist
  • Junciton City, KS
National Provider Identifier
1528507258
Registry record updated Jan 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1103031 Issued in KS
Legal business name
MELLEVORE, LLC
Doing business as
Mathis Physical Therapy
Practice address
935 E 4TH St
Junciton City, KS 66441
Phone
(785) 579-6790
Fax
(785) 579-6792
NPI assigned
Feb 14, 2017
Last updated
Jan 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2020

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

Authorized official

Name
Jeffrey Mathis, OTD, CHT
Title
Owner
Phone
(785) 320-6616

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1103031 KS Primary
Occupational Therapist 225X00000X 1700445 KS
Speech-Language Pathologist 235Z00000X 3339 KS

Addresses

Primary practice location

935 E 4TH St
Junciton City, KS 66441

Mailing address

1228 Westloop PL
#159
Manhattan, KS 66502-2840

Other names 1

  • Mathis Physical Therapy Doing business as

National Provider Directory

National Provider Directory

Locations

1228 Westloop Pl
#159
Manhattan, KS 66502

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1487030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579737600000",
    "number": "1528507258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1228 WESTLOOP PL",
            "address_2": "#159",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665022840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 E 4TH ST",
            "city": "JUNCITON CITY",
            "state": "KS",
            "postal_code": "66441",
            "telephone_number": "785-579-6790",
            "fax_number": "785-579-6792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELLEVORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-14",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A",
        "authorized_official_last_name": "MATHIS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "785-320-6616",
        "authorized_official_credential": "OTD, CHT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "1103031",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "KS",
            "license": "1700445",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "KS",
            "license": "3339",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mathis Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mathis Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.