Southern Ohio Sports Medicine and Physical Therapy

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT 5740 Issued in OH

Legal business name

SOUTHERN OHIO SPORTS MEDICINE AND PHYSICAL THERAPY

Practice address

118 Rarden Rd
Peebles, OH 45660-1049

Phone

(937) 587-9422

Fax

(937) 587-9522

NPI assigned

Nov 30, 2010

Last updated

Nov 30, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Melissa Mae Waddell, PTNPI 1043307333

Title

Physical Therapist

Phone

(937) 587-9422

Specialties & licenses 1

Addresses

Other names 1

• Southern Ohio Sports Medicine and Physical Therapy Former legal business name

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 1

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.

• Melissa Mae Waddell, P.T.

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Peebles, OH
  • NPI 1043307333
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1291075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291075200000",
    "number": "1700188463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 RARDEN RD",
            "city": "PEEBLES",
            "state": "OH",
            "postal_code": "456601049",
            "telephone_number": "937-587-9422",
            "fax_number": "937-587-9522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 RARDEN RD",
            "city": "PEEBLES",
            "state": "OH",
            "postal_code": "456601049",
            "telephone_number": "937-587-9422",
            "fax_number": "937-587-9522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN OHIO SPORTS MEDICINE AND PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-30",
        "last_updated": "2010-11-30",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "937-587-9422",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "OH",
            "license": "PT 5740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Ohio Sports Medicine and Physical Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Lucinda Jean Leslie Singh
• Neva Marie Smalley, LPCC
• Sarah Smith Cook
• Melissa Lynn Sorenson
• Southern Ohio Medical Inc
• Blake Spiller
• Jama Stephens, LPN
• Vanessa Lynn Stephenson
• Gail Ann Storer, HOME HEALTH AIDE
• Sherry Lynn Stratton

• Specialist in Peebles, OH
• Providers in Peebles, OH by specialty
• Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.