Active NPI
Molly Mattingly
- Physical Therapist
- Greenwood, IN
National Provider Identifier
1730234550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05006668A
- Practice address
- 1273 N Emerson Ave
Suite E
Greenwood, IN 46143-6672 - Phone
- (317) 807-0770
- Fax
- (317) 807-0771
- NPI assigned
- Jan 24, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 05006668A | IN | Primary |
Addresses
Primary practice location
1273 N Emerson Ave
Suite E
Greenwood, IN 46143-6672
Mailing address
625 Enterprise Dr
Oak Brook, IL 60523-8813
Phone (630) 575-1980
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100133720K | Medicaid | IN |
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 |
|---|---|---|---|
| 05006668A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493078400000",
"number": "1730234550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 ENTERPRISE DR",
"city": "OAK BROOK",
"state": "IL",
"postal_code": "605238813",
"telephone_number": "630-575-1980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1273 N EMERSON AVE",
"address_2": "SUITE E",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461436672",
"telephone_number": "317-807-0770",
"fax_number": "317-807-0771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTINGLY",
"first_name": "MOLLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2017-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05006668A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100133720K",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.