Mikenzi Pettenger, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT42809 Issued in FL

Practice address

1865 Lpga Blvd
Daytona Beach, FL 32117-7108

Phone

(386) 258-4596

Fax

(386) 258-3561

NPI assigned

Feb 10, 2025

Sex

Female

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 FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Premier Wellness Centers LLCGroup PAC ID 8527122241, 4 clinicians

Orthopaedic Clinic of Daytona Beach PAGroup PAC ID 9335123504, 48 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/10735/brand/1/csg/1/fhir/r4
• Direct secure messaging: mikenzi.pettenger.1@10735.direct.athenahealth.com

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.

• Orthopaedic Clinic of Daytona Beach PA

  • Orthopaedic Surgery Physician
  • Daytona Beach, FL
  • NPI 1558340240
  Medicare reassignment Care Compare group NPD
• Premier Wellness Centers LLC

  • Chiropractor
  • Port St Lucie, FL
  • NPI 1639322712
  Medicare reassignment Care Compare group
• Orthopaedic Clinic of Daytona Beach PA

  • Durable Medical Equipment & Medical Supplies
  • Port Orange, FL
  • NPI 1023678745
  NPD

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

{
    "created_epoch": "1739145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1093520850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1865 LPGA BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177108",
            "telephone_number": "386-258-4596",
            "fax_number": "386-258-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1865 LPGA BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177108",
            "telephone_number": "386-258-4596",
            "fax_number": "386-258-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTENGER",
        "first_name": "MIKENZI",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-10",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT42809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kishmar Petersen
• Daniel Peterson
• Linda Bebee Peterson, RN
• Vincent Glenn Peterson, D.O.
• Charlene Petretti, RN
• Samantha Kate Pettigrew
• Troi Pettway
• John Phan, PHARMD
• Celeste M Philip, M.D.
• Alexandra Phillips, CRNA DNAP

• Physical Therapist in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.