Mary Ellen Stephenson, BSPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

00476 Issued in MO

Practice address

502 W 5TH St
MSSD Skyview School #30
Mountain Grove, MO 65711-1435

Phone

(417) 926-4880

Fax

(417) 926-5044

NPI assigned

Mar 13, 2007

Last updated

May 11, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494460800000",
    "number": "1831222363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3338 KNOW IT ALL LN",
            "city": "ROGERSVILLE",
            "state": "MO",
            "postal_code": "657427599",
            "telephone_number": "417-860-6319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 W 5TH ST",
            "address_2": "MSSD SKYVIEW SCHOOL #30",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "657111435",
            "telephone_number": "417-926-4880",
            "fax_number": "417-926-5044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENSON",
        "first_name": "MARY",
        "middle_name": "ELLEN",
        "name_prefix": "Mrs.",
        "credential": "BSPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2017-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "00476",
            "primary": false
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "MO",
            "license": "00476",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "MO",
            "license": "00476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366582827",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Ann Shockley, L.P.C.
• Jeremy Ryan Skeen, P.T.
• Francis Louise Smith, ADMINISTRATOR
• Spurling and White LLC (Grove Family Care)
• St Johns Clinic Inc (SJC-Mountain Grove)
• Micheala Stewart, APRN, FNP-C
• Sheri L Stofer, PA-C
• James R Stovall, PT,ATC,CSCS
• Paula Sykes, MS
• Tonnya Marie Taggart, FNP

• Pediatric Physical Therapist in Mountain Grove, MO
• Providers in Mountain Grove, MO by specialty
• Pediatric Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; 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.