Mary Vivian Mantooth, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT001004 Issued in KY

Practice address

358 S Main St
Leitchfield, KY 42754-1428

Phone

(270) 259-0551

Fax

(270) 230-0009

NPI assigned

Jul 19, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Mary Vivian Hayden Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• The P.T. Place, Inc

  • Physical Therapy Clinic/Center
  • Leitchfield, KY
  • NPI 1306901020

  Physical Therapist

  NPD
• Fuller Physical Therapy

  • Physical Therapist
  • Beaver Dam, KY
  • NPI 1477857423
  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196899200000",
    "number": "1780603787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "358 SOUTH MAIN STREET",
            "city": "LEITCHFIELD",
            "state": "KY",
            "postal_code": "42754",
            "telephone_number": "270-259-0551",
            "fax_number": "270-230-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "358 S MAIN ST",
            "city": "LEITCHFIELD",
            "state": "KY",
            "postal_code": "427541428",
            "telephone_number": "270-259-0551",
            "fax_number": "270-230-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTOOTH",
        "first_name": "MARY",
        "middle_name": "VIVIAN",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "PT001004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8700064200",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PASSPORT HEALTH",
            "identifier": "1072857",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000051788",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "HAYDEN",
            "middle_name": "VIVIAN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Laura Lucas
• Debra S Lusk, APRN
• John Anthony Lyons, CRNA
• Rodney D Mann, CRNA
• Mantooth Physical Therapy, LLC
• Veronica Sue Masden
• Jamie Mathis, RBT
• Amy Nicole Mattingly
• Angela Dawn McCray, P.T.
• Hannah Nicole McDowell

• Physical Therapist in Leitchfield, KY
• Providers in Leitchfield, KY by specialty
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.

Verify at the official NPI Registry.