Active NPI
Mary Melillo
- Physical Therapist
- Pacific, MO
National Provider Identifier
1780794610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 307 Noonan Dr
Pacific, MO 63069-1118 - Phone
- (636) 271-9995
- NPI assigned
- Aug 30, 2006
- 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 | Primary |
Addresses
Primary practice location
307 Noonan Dr
Pacific, MO 63069-1118
Mailing address
3233 Highway F
Defiance, MO 63341-1213
Phone (636) 828-6012
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R0963 | Other | MO | LICENSE # |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780794610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3233 HIGHWAY F",
"city": "DEFIANCE",
"state": "MO",
"postal_code": "633411213",
"telephone_number": "636-828-6012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 NOONAN DR",
"city": "PACIFIC",
"state": "MO",
"postal_code": "630691118",
"telephone_number": "636-271-9995"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELILLO",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "R0963",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pacific, MO
- Matthew Ryan Leonard, DPT, DC
- Jeannine Lisa Liebmann, MA. LPC
- Tina Lusk, DNP, APRN, PMHNP-BC
- Debra Kay Lyons, LPC
- Kathleen McAuliffe, DPT
- Melissa Georgevitch Chiropractic LLC
- Meramec Valley R3 School District
- Stephanie M Meyer, MD
- Missouri CVS Pharmacy LLC (CVS Pharmacy #10773)
- Stephanie L. Murphy, DC
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.