Individual provider Active NPI

Carissa Lynn Novelli, PT, DPT

  • Physical Therapist
  • Medford, NJ
National Provider Identifier
1194407254
Registry record updated Aug 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA02194100 Issued in NJ
Practice address
103 Old Marlton Pike Ste 111
Medford, NJ 08055-8772
Phone
(609) 451-8088
Fax
(609) 451-8089
NPI assigned
Aug 7, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2023

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 40QA02194100 NJ Primary

Addresses

Primary practice location

103 Old Marlton Pike Ste 111
Medford, NJ 08055-8772

Mailing address

1650 Lyndon Farm CT Ste 300
Louisville, KY 40223-5005
Phone (856) 677-4000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230928001005 NJ Practitioner - Physical Therapist in Private Practice 9436503166 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
Strive Physical Therapy Specialists LLCGroup PAC ID 6709292535, 163 clinicians

Practice addresses (Care Compare)

103 Old Marlton Pike
Suite 111
Medford, NJ 08055-8772
Phone (609) 451-8088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Strive Physical Therapy Specialists LLC Physical Therapist CurrentSince Aug 5, 2023 Accepting new patients
Strive Physical Therapy Specialists LLC CurrentSince Aug 5, 2023 Accepting new patients
Strive Physical Therapy Specialists LLC Physical Therapist Past Accepting new patients

Locations

1650 Lyndon Farm Ct
Ste 300
Louisville, KY 40223
Phone (726) 202-3039

103 Old Marlton Pike
Ste 111
Medford, NJ 08055
Phone (609) 451-8088

1 Rossmoor Dr
Ste 101
Monroe Twp, NJ 08831
Phone (609) 860-9913

740 Marne Hwy
Ste 203
Moorestown, NJ 08057
Phone (856) 914-1400

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": "1691366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1194407254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 LYNDON FARM CT STE 300",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402235005",
            "telephone_number": "856-677-4000",
            "fax_number": "856-234-3014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 OLD MARLTON PIKE STE 111",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080558772",
            "telephone_number": "609-451-8088",
            "fax_number": "609-451-8089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOVELLI",
        "first_name": "CARISSA",
        "middle_name": "LYNN",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-07",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA02194100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; 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.