Mary Susan Pernell, LPTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

116138 Issued in MO

Practice address

2011 Corona Rd Ste 301
Columbia, MO 65203-2548

Phone

(314) 543-3861

NPI assigned

Sep 29, 2012

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 names 1

• Mary Susan Peck Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Reliant Care Rehabilitative Services

  • Nursing Facility/Intermediate Care Facility
  • Ferguson, MO
  • NPI 1376893297
  NPD (past) Authorized official
• Reliant Care Rehabilitation Services

  • Skilled Nursing Facility
  • Columbia, MO
  • NPI 1336497833
  NPD (past)

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

{
    "created_epoch": "1348876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348876800000",
    "number": "1861743817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 ROBERT AVE",
            "city": "FERGUSON",
            "state": "MO",
            "postal_code": "631353526",
            "telephone_number": "314-524-6191",
            "fax_number": "314-524-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2011 CORONA RD STE 301",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652032548",
            "telephone_number": "314-543-3861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERNELL",
        "first_name": "MARY",
        "middle_name": "SUSAN",
        "credential": "LPTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-29",
        "last_updated": "2012-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "116138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "PECK",
            "middle_name": "SUSAN",
            "credential": "LPTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Holley Pering
• Jeffrey Scott Perkins, LCSW
• Michael Perkins, PHARMD
• Paige Perkins
• Lora Perkinson, PHARMD
• Chris Perrin, MS, ATC
• Cameron Miller Perrine, PHD
• Courtney Blankenship Perry, MA, LPC
• Lindall A Perry, M.D.
• Marla Sue Perryman, MSW, LCSW

• Physical Therapy Assistant in Columbia, MO
• Providers in Columbia, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2012; 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.