Ian Lei Modde, PT, DPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

Practice address

11365 Dorsett Rd
Maryland Heights, MO 63043-3411

Phone

(314) 872-6400

NPI assigned

Dec 4, 2023

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1701648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1962279653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 W ARGONNE DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631224133",
            "telephone_number": "314-623-5017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11365 DORSETT RD",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630433411",
            "telephone_number": "314-872-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODDE",
        "first_name": "IAN",
        "middle_name": "LEI",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-04",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Milewski
• Kathy Miller, NP
• Matthew Miriani, D.O.
• Missouri CVS Pharmacy, L.L.C.
• Nancy Paulk Mobley, LPC
• Rashid Muhammad, MA; LCPC-IL; LPC-MO
• Megan Murphy, COTA
• Myriad Medical Testing Solutions LLC
• Nathan Suter DDS Mobile LLC
• Nathional Health Care, Maryland Heights

• All providers in Maryland Heights, MO
• Pediatric Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; 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.