John Nason Pettengill, MSPT, CERT MDT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT005964L Issued in PA

Practice address

434 W Aaron Dr
Suite104
State College, PA 16803-3074

Phone

(814) 235-9995

Fax

(814) 235-9616

NPI assigned

Sep 7, 2006

Sex

Male

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 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Back to Life Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • State College, PA
  • NPI 1033220470

  Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811090368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 HUNTER WOOD WAY",
            "city": "PORT MATILDA",
            "state": "PA",
            "postal_code": "168707037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 W AARON DR",
            "address_2": "SUITE104",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168033074",
            "telephone_number": "814-235-9995",
            "fax_number": "814-235-9616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTENGILL",
        "first_name": "JOHN",
        "middle_name": "NASON",
        "credential": "MSPT, CERT MDT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT005964L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE",
            "identifier": "PT005964L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heidi Brooks Peters, MA, CCC-SLP
• Nicholas Peters, LMT
• Emily Ann Peterson, MD
• David Joseph Petkus, PA-C
• Angela J Petrick, PT
• Kathy Pettet
• Maria T. Pettinger, M.D.
• Tyler Adam Pezalski, M.D.
• Matthew Phillips
• Stephen Harry Phillips II, D.O.

• Physical Therapist in State College, PA
• Providers in State College, PA by specialty
• Physical Therapist in Pennsylvania

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.