Active NPI
Marivic Mallari Chang, PT,DPT,CKTP
- Physical Therapist
- Jacksonville, FL
National Provider Identifier
1578748059
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 23745
- Practice address
- 9527 Regency Square Blvd Ste 105
Jacksonville, FL 32225-8807 - Phone
- (904) 647-4263
- Fax
- (904) 855-4010
- NPI assigned
- Jan 3, 2008
- Last updated
- Jul 21, 2022
- Sex
- Female
- 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 | 23745 | FL | Primary |
Addresses
Primary practice location
9527 Regency Square Blvd Ste 105
Jacksonville, FL 32225-8807
Mailing address
1128 Creeks Ridge Rd
Jacksonville, FL 32225-7335
Phone (904) 755-9071
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23745 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1578748059",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1128 CREEKS RIDGE RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322257335",
"telephone_number": "904-755-9071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9527 REGENCY SQUARE BLVD STE 105",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322258807",
"telephone_number": "904-647-4263",
"fax_number": "904-855-4010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANG",
"first_name": "MARIVIC",
"middle_name": "MALLARI",
"name_prefix": "Dr.",
"credential": "PT,DPT,CKTP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-01-03",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "23745",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.