Active NPI
Raymond Mallory, P.T.
- Physical Therapist
- Duxbury, MA
National Provider Identifier
1972511715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6491
- Practice address
- 95 Tremont St
Suite 20
Duxbury, MA 02332-4738 - Phone
- (781) 934-7292
- Fax
- (781) 934-8112
- NPI assigned
- Aug 4, 2006
- 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 | 6491 | MA | Primary |
Addresses
Primary practice location
95 Tremont St
Suite 20
Duxbury, MA 02332-4738
Mailing address
55 Allan St
Marshfield, MA 02050-5101
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MAY67953 | Other | MA | BLUE SHIELD |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6491 | MA | MD | Children's Rehabilitation Hospital |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972511715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 ALLAN ST",
"city": "MARSHFIELD",
"state": "MA",
"postal_code": "020505101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "95 TREMONT ST",
"address_2": "SUITE 20",
"city": "DUXBURY",
"state": "MA",
"postal_code": "023324738",
"telephone_number": "781-934-7292",
"fax_number": "781-934-8112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLORY",
"first_name": "RAYMOND",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "6491",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "MAY67953",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Duxbury, MA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.