Active NPI
Kim Mallon
- Physical Therapist
- Virginia Beach, VA
National Provider Identifier
1982906202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2305204928
- Practice address
- 4560 South Blvd
Virginia Beach, VA 23452-1160 - Phone
- (757) 490-3223
- NPI assigned
- Nov 18, 2010
- 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 Therapist | 225100000X | 2305204928 | VA | Primary |
Addresses
Primary practice location
4560 South Blvd
Virginia Beach, VA 23452-1160
Mailing address
24030 Indian Town Rd
Courtland, VA 23837-2371
Phone (757) 812-3288
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 |
|---|---|---|---|
| 2305204928 | VA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Therapy Concepts LLC | 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.
-
- Early Intervention Provider Agency
- Courtland, VA
- NPI 1043769615
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491350400000",
"number": "1982906202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24030 INDIAN TOWN RD",
"city": "COURTLAND",
"state": "VA",
"postal_code": "238372371",
"telephone_number": "757-812-3288",
"fax_number": "757-612-4499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4560 SOUTH BLVD",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234521160",
"telephone_number": "757-490-3223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLON",
"first_name": "KIM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-11-18",
"last_updated": "2017-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305204928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.