Mallory Wanserski, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

0017354 Issued in CO

Practice address

710 N Summit Blvd Unit 103
Frisco, CO 80443-5666

Phone

(970) 368-6908

Fax

(970) 368-6910

NPI assigned

Dec 11, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Axis Sports Medicine LLCGroup PAC ID 7214188895, 18 clinicians

Vail Clinic IncGroup PAC ID 3577475714, 117 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Axis Sports Medicine, LLC

  • Physical Therapist
  • Avon, CO
  • NPI 1952652984
  Medicare reassignment Care Compare group NPD
• Vail Clinic, Inc.

  • General Acute Care Hospital
  • Vail, CO
  • NPI 1992812333
  Medicare reassignment Care Compare group
• Axis Sports Medicine, LLC

  • Physical Therapist
  • Breckenridge, CO
  • NPI 1750049821
  NPD
• Vail Clinic Inc

  • General Acute Care Hospital
  • Edwards, CO
  • NPI 1144876251
  NPD
• Vail Clinic, Inc.

  • General Acute Care Hospital
  • Edwards, CO
  • NPI 1659151009
  NPD
• Axis Sports Medicine, LLC

  • Physical Therapist
  • Frisco, CO
  • NPI 1881351088
  NPD (past)

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

{
    "created_epoch": "1607644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607644800000",
    "number": "1619563863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5584",
            "city": "FRISCO",
            "state": "CO",
            "postal_code": "804435584",
            "telephone_number": "970-406-2559",
            "fax_number": "970-453-2365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 N SUMMIT BLVD UNIT 103",
            "city": "FRISCO",
            "state": "CO",
            "postal_code": "804435666",
            "telephone_number": "970-368-6908",
            "fax_number": "970-368-6910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANSERSKI",
        "first_name": "MALLORY",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-11",
        "last_updated": "2020-12-11",
        "certification_date": "2020-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "15240-24",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "0017354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kami K Wallner, DDS
• Walmart Inc.
• Olivia Washburn
• Lucas Webb
• Sarah J Webb, RDH
• Marcia Wessels, PHARMD
• Julie Dawn Westcott, NP

• Physical Therapist in Frisco, CO
• Providers in Frisco, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.