Individual provider Active NPI

Callie Ariane Mousley

  • Physical Therapist
  • Carbondale, PA
National Provider Identifier
1114781663
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT032089 Issued in PA
Practice address
82 N Main St
Carbondale, PA 18407-1914
Phone
(570) 282-0200
Fax
(570) 282-2229
NPI assigned
Feb 6, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT032089 PA Primary

Addresses

Primary practice location

82 N Main St
Carbondale, PA 18407-1914

Mailing address

2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (570) 550-0168

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240308001044 PA Practitioner - Physical Therapist in Private Practice 7315383684 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pivot Physical Therapy of Pennsylvania LLCGroup PAC ID 4981971843, 123 clinicians

Practice addresses (Care Compare)

82 N Main St
Suite 1
Carbondale, PA 18407-1914
Phone (570) 282-0200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT032089PAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Procare Physical Therapy Inc Physical Therapist CurrentSince Feb 12, 2024 Accepting new patients
Pivot Physical Therapy of Pennsylvania, LLC Physical Therapist CurrentSince Feb 12, 2024 Accepting new patients
Dynamic Therapy Services, LLC Physical Therapist Past Accepting new patients

Locations

2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250

82 N Main St
Ste 1
Carbondale, PA 18407
Phone (570) 282-0200

655 Northern Blvd
South Abington Township, PA 18411
Phone (570) 587-2142

130 W Main St
Ste 100B
Trappe, PA 19426
Phone (484) 471-6850

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1707177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707264000000",
    "number": "1114781663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "570-550-0168",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 N MAIN ST",
            "city": "CARBONDALE",
            "state": "PA",
            "postal_code": "184071914",
            "telephone_number": "570-282-0200",
            "fax_number": "570-282-2229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUSLEY",
        "first_name": "CALLIE",
        "middle_name": "ARIANE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-06",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT032089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; 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.