Individual provider Active NPI

Jessica Lynn Mitchell, D.P.T.

  • Physical Therapist
  • Valley Cottage, NY
National Provider Identifier
1194099044
Registry record updated Nov 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
029609-1 Issued in NY
Practice address
7 New Lake Rd
Valley Cottage, NY 10989-1868
Phone
(845) 809-8176
NPI assigned
Feb 23, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 19, 2020

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 029609-1 NY Primary

Addresses

Primary practice location

7 New Lake Rd
Valley Cottage, NY 10989-1868

Mailing address

25 Table Rock Rd
Tuxedo Park, NY 10987-4721
Phone (845) 325-3271

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201120000061 NY Practitioner - Physical Therapist in Private Practice 5092126250 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
029609-1NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Stern at Home Physical Therapy PC Physical Therapist CurrentSince Jan 2, 2024 Accepting new patients

Locations

4 Medical Park Dr
Ste B
Pomona, NY 10970
Phone (845) 354-3131

Organizations & group practices 1

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": "1329955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1194099044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 TABLE ROCK RD",
            "city": "TUXEDO PARK",
            "state": "NY",
            "postal_code": "109874721",
            "telephone_number": "845-325-3271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 NEW LAKE RD",
            "city": "VALLEY COTTAGE",
            "state": "NY",
            "postal_code": "109891868",
            "telephone_number": "845-809-8176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "D.P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-23",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "029609-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Cottage, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; 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.