Active NPI
Mary Matthiesen, P.T.
- Physical Therapist
- McHenry, IL
National Provider Identifier
1730361114
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070003889
- Practice address
- 319 Front St
McHenry, IL 60050-5504 - Phone
- (815) 578-9655
- Fax
- (815) 578-9642
- NPI assigned
- Nov 28, 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 | 070003889 | IL | Primary |
Addresses
Primary practice location
319 Front St
McHenry, IL 60050-5504
Mailing address
319 Front St
McHenry, IL 60050-5504
Phone (815) 578-9655
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conroy Sports Physical Therapy LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- McHenry, IL
- NPI 1598882391
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1201046400000",
"number": "1730361114",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "319 FRONT ST",
"city": "MCHENRY",
"state": "IL",
"postal_code": "600505504",
"telephone_number": "815-578-9655",
"fax_number": "815-578-9642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "319 FRONT ST",
"city": "MCHENRY",
"state": "IL",
"postal_code": "600505504",
"telephone_number": "815-578-9655",
"fax_number": "815-578-9642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTHIESEN",
"first_name": "MARY",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-28",
"last_updated": "2008-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070003889",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McHenry, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.