Active NPI
John T Groom
- Physical Therapy Assistant
- Mankato, KS
National Provider Identifier
1750196432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 14-03623
- Practice address
- 100 Crestvue Ave
Mankato, KS 66956-2407 - Phone
- (785) 378-3137
- NPI assigned
- Feb 11, 2025
- 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 Therapy Assistant | 225200000X | 14-03623 | KS | Primary |
Addresses
Primary practice location
100 Crestvue Ave
Mankato, KS 66956-2407
Mailing address
610 N Caddy LN
Wichita, KS 67212-4610
Phone (316) 719-9569
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 |
|---|---|---|---|
| 14-03623 | KS | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739232000000",
"number": "1750196432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 N CADDY LN",
"city": "WICHITA",
"state": "KS",
"postal_code": "672124610",
"telephone_number": "316-719-9569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 CRESTVUE AVE",
"city": "MANKATO",
"state": "KS",
"postal_code": "669562407",
"telephone_number": "785-378-3137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROOM",
"first_name": "JOHN",
"middle_name": "T",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-02-11",
"last_updated": "2025-02-11",
"certification_date": "2025-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "KS",
"license": "14-03623",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mankato, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.