Active NPI
Mary Amanda Weilenman Sellers
- Physical Therapist
- Canton, MS
National Provider Identifier
1750686523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT3632
- Practice address
- 110 E Center St
Canton, MS 39046-3733 - Phone
- (601) 717-0910
- Fax
- (601) 667-3203
- NPI assigned
- Jan 25, 2011
- Last updated
- Jan 25, 2011
- 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 | PT3632 | MS | Primary |
Addresses
Primary practice location
110 E Center St
Canton, MS 39046-3733
Mailing address
110 E Center St
Canton, MS 39046-3733
Phone (601) 717-0910
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 |
|---|---|---|---|
| PT3632 | MS | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295913600000",
"number": "1750686523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 E CENTER ST",
"city": "CANTON",
"state": "MS",
"postal_code": "390463733",
"telephone_number": "601-717-0910",
"fax_number": "601-667-3203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 E CENTER ST",
"city": "CANTON",
"state": "MS",
"postal_code": "390463733",
"telephone_number": "601-717-0910",
"fax_number": "601-667-3203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELLERS",
"first_name": "MARY AMANDA",
"middle_name": "WEILENMAN",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-01-25",
"last_updated": "2011-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MS",
"license": "PT3632",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.