Active NPI
Craig G Mennenga, PT
- Physical Therapist
- Waverly, IA
National Provider Identifier
1831421049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 00430
- Practice address
- 1810 4TH St SW Ste 103B
Waverly, IA 50677-4389 - Phone
- (319) 352-4544
- Fax
- (319) 352-4655
- NPI assigned
- Feb 12, 2010
- Sex
- Male
- 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 | 00430 | IA | Primary |
Addresses
Primary practice location
1810 4TH St SW Ste 103B
Waverly, IA 50677-4389
Mailing address
1810 4TH St SW Ste 103B
Waverly, IA 50677-4389
Phone (319) 352-4544
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0665992 | Medicaid | IA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00430 | IA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265932800000",
"number": "1831421049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1810 4TH ST SW STE 103B",
"city": "WAVERLY",
"state": "IA",
"postal_code": "506774389",
"telephone_number": "319-352-4544",
"fax_number": "319-352-4655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1810 4TH ST SW STE 103B",
"city": "WAVERLY",
"state": "IA",
"postal_code": "506774389",
"telephone_number": "319-352-4544",
"fax_number": "319-352-4655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENNENGA",
"first_name": "CRAIG",
"middle_name": "G",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-12",
"last_updated": "2010-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IA",
"license": "00430",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0665992",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waverly, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.