Jarrett Thomas Mattingly, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A04536 Issued in KY

Practice address

190 Shadowmeade LN
Mount Washington, KY 40047-6277

Phone

(502) 538-2332

NPI assigned

Jun 12, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1718150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1992548523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 N MAIN ST",
            "city": "NEW HAVEN",
            "state": "KY",
            "postal_code": "400516343",
            "telephone_number": "502-827-3347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 SHADOWMEADE LN",
            "city": "MOUNT WASHINGTON",
            "state": "KY",
            "postal_code": "400476277",
            "telephone_number": "502-538-2332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "JARRETT",
        "middle_name": "THOMAS",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-12",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "KY",
            "license": "A04536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra Lewandowski
• Gary W Lewis
• Anne Lopez, RN
• Amber Manion, MS CCC-SLP
• Mark Orgel, MD, PLLC
• Tamara Mazzoccoli, CSW
• Erica B McCubbin
• Jessica McDermott, PHARMD
• Ryan McGiffen, O.D.
• Haley McVey, LCSW

• Physical Therapy Assistant in Mount Washington, KY
• Providers in Mount Washington, KY by specialty
• Physical Therapy Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.