Mallory Ann Doedtman, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070.019727 Issued in IL

Practice address

12704 E 1975TH Ave
Effingham, IL 62401-6874

Phone

(217) 821-4715

NPI assigned

Jun 6, 2013

Last updated

Jun 6, 2013By the provider in NPPES

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

• Mallory Ann Althoff Former name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Empowerme Rehabilitation Illinois LLCGroup PAC ID 2365718277, 361 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Empowerme Rehabilitation Illinois, LLC

  • Occupational Therapist
  • Edwardsville, IL
  • NPI 1679098263

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Empowerme Wellness Kansas City, LLC

  • Multi-Specialty Clinic/Center
  • Belleville, IL
  • NPI 1174118103

  Physical Therapist

  Medicare reassignment NPD
• Empowerme Rehabilitation Illinois, LLC

  • Rehabilitation Clinic/Center
  • Mount Carmel, IL
  • NPI 1962073734

  Physical Therapist

  NPD
• Empowerme Wellness Kansas City, LLC

  • Rehabilitation Clinic/Center
  • Liberty, MO
  • NPI 1174299044
  NPD

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

{
    "created_epoch": "1370476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370476800000",
    "number": "1982042461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12704 E 1975TH AVE",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624016874",
            "telephone_number": "217-821-4715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12704 E 1975TH AVE",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624016874",
            "telephone_number": "217-821-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOEDTMAN",
        "first_name": "MALLORY",
        "middle_name": "ANN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-06",
        "last_updated": "2013-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.019727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "ALTHOFF",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Diel Counseling Inc.
• Dara G Diel, R.N.
• Patricia R. Diel, LSW, CADC, SAP
• Brandi Dinh
• Krishna Dipnarine
• Rebekah E Doty, FNP-C
• Diana Dragnea
• Christopher Gerard Dreas, D.C.
• DRS. Sehy and Jones Optometrists, P.C.
• Casey Ellis Duncan, MD

• Physical Therapist in Effingham, IL
• Providers in Effingham, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.