NPIMap

Organization Active NPI

MDM Physical Therapy, LLC

Doing business as MDM Physical Therapy

  • Physical Therapist
  • Mesa, AZ
National Provider Identifier
1730251133
Registry record updated May 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2346 Issued in AZ
Legal business name
MDM PHYSICAL THERAPY, LLC
Doing business as
MDM Physical Therapy
Practice address
7205 E Southern Ave Ste 111
Mesa, AZ 85209-2791
Phone
(480) 832-9308
Fax
(480) 807-1782
NPI assigned
Nov 14, 2006
Last updated
May 22, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2019

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

Authorized official

Name
Mr. Mark D Mooney, PTNPI 1306918701
Title
Owner
Phone
(480) 854-9833

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2346 AZ Primary

Addresses

Primary practice location

7205 E Southern Ave Ste 111
Mesa, AZ 85209-2791

Mailing address

1101 E Princeton Ave
Gilbert, AZ 85234-3599
Phone (480) 854-9833

Other names 1

  • MDM Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130206000224 AZ Part B Supplier - Clinic/Group Practice 8820242563 Receives reassigned benefits from 8 practitioners
Practice locations: Mesa, AZ

National Provider Directory

National Provider Directory

Locations

1440 S Clearview Ave
Ste 104
Mesa, AZ 85209
Phone (480) 689-5999

7205 E Southern Ave
Ste 111
Mesa, AZ 85209
Phone (480) 832-9308

7254 E Southern Ave
Ste 103
Mesa, AZ 85209
Phone (480) 832-9308

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558483200000",
    "number": "1730251133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 E PRINCETON AVE",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852343599",
            "telephone_number": "480-854-9833",
            "fax_number": "480-854-9834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7205 E SOUTHERN AVE STE 111",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852092791",
            "telephone_number": "480-832-9308",
            "fax_number": "480-807-1782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MDM PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2019-05-22",
        "status": "A",
        "authorized_official_last_name": "MOONEY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-854-9833",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "2346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MDM Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; 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.