Jordan Marie Mantels

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2014037305 Issued in MO

Practice address

509 W 18TH St
Hermann, MO 65041-1547

Phone

(573) 486-2154

NPI assigned

Oct 28, 2021

Last updated

Oct 28, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1635379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1649934324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 HILLCREST DR",
            "city": "OWENSVILLE",
            "state": "MO",
            "postal_code": "650662823",
            "telephone_number": "573-301-2278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 W 18TH ST",
            "city": "HERMANN",
            "state": "MO",
            "postal_code": "650411547",
            "telephone_number": "573-486-2154"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1016 W Highway 28",
            "address_purpose": "LOCATION",
            "city": "Owensville",
            "state": "MO",
            "postal_code": "650661677",
            "country_code": "US",
            "telephone_number": "573-437-6877",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANTELS",
        "first_name": "JORDAN",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-28",
        "last_updated": "2021-10-28",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2014037305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Hermann, MO
• Providers in Hermann, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; 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.