Active NPI
Mardone Rivera Tan, PT
- Physical Therapist
- Ormond Beach, FL
National Provider Identifier
1740306190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 22587
- Practice address
- 350 S Ridgewood Ave
Ormond Beach, FL 32174-7028 - Phone
- (386) 677-4545
- NPI assigned
- Mar 21, 2007
- Sex
- Male
- 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 | PT 22587 | FL | Primary |
Addresses
Primary practice location
350 S Ridgewood Ave
Ormond Beach, FL 32174-7028
Mailing address
503 Crowne Sunset Dr
Apt. 1323
Ormond Beach, FL 32174-0666
Phone (407) 929-9165
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 |
|---|---|---|---|
| PT 22587 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1740306190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "503 CROWNE SUNSET DR",
"address_2": "APT. 1323",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321740666",
"telephone_number": "407-929-9165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 S RIDGEWOOD AVE",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321747028",
"telephone_number": "386-677-4545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "MARDONE",
"middle_name": "RIVERA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT 22587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ormond Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.