Active NPI
Mark Noel Pettus, RPT
- Physical Therapist
- Overland Park, KS
National Provider Identifier
1992073647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11-01203
- Practice address
- 14631 Floyd St
Overland Park, KS 66223-2244 - Phone
- (913) 486-2207
- Fax
- (913) 897-0248
- NPI assigned
- Dec 8, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 | 11-01203 | KS | Primary |
Addresses
Primary practice location
14631 Floyd St
Overland Park, KS 66223-2244
Mailing address
14631 Floyd St
Overland Park, KS 66223-2244
Phone (913) 486-2207
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 |
|---|---|---|---|
| 11-01203 | KS | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323302400000",
"number": "1992073647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14631 FLOYD ST",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662232244",
"telephone_number": "913-486-2207",
"fax_number": "913-897-0248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14631 FLOYD ST",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662232244",
"telephone_number": "913-486-2207",
"fax_number": "913-897-0248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTUS",
"first_name": "MARK",
"middle_name": "NOEL",
"name_prefix": "Mr.",
"credential": "RPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-08",
"last_updated": "2011-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KS",
"license": "11-01203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Overland Park, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.