Active NPI
Destinee Mullinix, PTA
- Physical Therapy Assistant
- Neosho, MO
National Provider Identifier
1093271298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2018026836
- Practice address
- 1105 Village Rd
Neosho, MO 64850-9076 - Phone
- (800) 381-0822
- Fax
- (352) 565-5201
- NPI assigned
- Feb 13, 2019
- 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 Therapy Assistant | 225200000X | 2018026836 | MO | Primary |
Addresses
Primary practice location
1105 Village Rd
Neosho, MO 64850-9076
Mailing address
8477 S Suncoast Blvd
Homosassa, FL 34446-5028
Phone (800) 381-0822
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2018026836 | Other | MO | PTA |
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 |
|---|---|---|---|
| 2018026836 | MO | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740960000000",
"number": "1093271298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8477 S SUNCOAST BLVD",
"city": "HOMOSASSA",
"state": "FL",
"postal_code": "344465028",
"telephone_number": "800-381-0822",
"fax_number": "352-565-5201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 VILLAGE RD",
"city": "NEOSHO",
"state": "MO",
"postal_code": "648509076",
"telephone_number": "800-381-0822",
"fax_number": "352-565-5201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLINIX",
"first_name": "DESTINEE",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-13",
"last_updated": "2025-03-03",
"certification_date": "2025-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MO",
"license": "2018026836",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTA",
"identifier": "2018026836",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Neosho, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.