Marco I Mirnics, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305215674 Issued in VA

Practice address

1585 3Rd St
Fort Johnson, LA 71459-5102

Phone

(615) 609-1424

NPI assigned

Jun 9, 2023

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

Enrolled in DC

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Jackson Clinics Limited Partnership

  • Physical Therapist
  • Centreville, VA
  • NPI 1639594831

  DC

  Medicare reassignment NPD
• The Jackson Clinics LLC

  • Physical Therapist
  • Middleburg, VA
  • NPI 1427034982
  NPD (past)

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

{
    "created_epoch": "1686268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1033893284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1585 3RD ST",
            "city": "FORT JOHNSON",
            "state": "LA",
            "postal_code": "714595102",
            "telephone_number": "615-609-1424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1585 3RD ST",
            "city": "FORT JOHNSON",
            "state": "LA",
            "postal_code": "714595102",
            "telephone_number": "615-609-1424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRNICS",
        "first_name": "MARCO",
        "middle_name": "I",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-09",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305215674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Quinne Johnson, OTR/L, OTD
• Lillian Rozanski Keppinger, RD
• Shelby Landrum, PT
• Laura London
• Joseph Lowery
• Zhenhai Niu
• Taylor Christopher Osborne
• Daniel A Palma, PHYSICIAN ASSISTANT
• Juan M Rodriguez, LPC
• Charles Alexander Rosado, DO

• Physical Therapist in Fort Johnson, LA
• Providers in Fort Johnson, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.