Active NPI
Maggie L Kennedy, PTA
- Physical Therapy Assistant
- Poteau, OK
National Provider Identifier
1972636371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1464
- Practice address
- 2104 N Broadway St
Suite B
Poteau, OK 74953-2501 - Phone
- (918) 649-0799
- Fax
- (918) 649-0797
- NPI assigned
- Mar 14, 2007
- Sex
- Female
- 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 Therapy Assistant | 225200000X | 1464 | OK | Primary |
Addresses
Primary practice location
2104 N Broadway St
Suite B
Poteau, OK 74953-2501
Mailing address
2104 N Broadway St
Suite B
Poteau, OK 74953-2501
Phone (918) 649-0799
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 |
|---|---|---|---|
| 1464 | OK | MD | Pediatric Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physical Therapy Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Poteau, OK
- NPI 1568412708
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972636371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2104 N BROADWAY ST",
"address_2": "SUITE B",
"city": "POTEAU",
"state": "OK",
"postal_code": "749532501",
"telephone_number": "918-649-0799",
"fax_number": "918-649-0797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2104 N BROADWAY ST",
"address_2": "SUITE B",
"city": "POTEAU",
"state": "OK",
"postal_code": "749532501",
"telephone_number": "918-649-0799",
"fax_number": "918-649-0797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "MAGGIE",
"middle_name": "L",
"name_prefix": "Mrs.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OK",
"license": "1464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Poteau, OK
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.