Active NPI
Charlton Marvin Mayo, PTA
- Physical Therapy Assistant
- Brooklyn, NY
National Provider Identifier
1669819553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 008894
- Practice address
- 8012 3Rd Ave
Brooklyn, NY 11209-3802 - Phone
- (718) 491-5454
- NPI assigned
- May 31, 2013
- 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 Therapy Assistant | 225200000X | 008894 | NY | Primary |
Addresses
Primary practice location
8012 3Rd Ave
Brooklyn, NY 11209-3802
Mailing address
8716 3Rd Avenue Apartment 5
Brooklyn, NY 11209
Phone (941) 276-2173
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 008894 | NY | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369958400000",
"number": "1669819553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8716 3RD AVENUE APARTMENT 5",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "11209",
"telephone_number": "941-276-2173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8012 3RD AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112093802",
"telephone_number": "718-491-5454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYO",
"first_name": "CHARLTON",
"middle_name": "MARVIN",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-05-31",
"last_updated": "2013-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "008894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.