Courtney Pickel, PT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT0000004719 Issued in TN

Practice address

1319 Sunset Dr
Suite 102
Johnson City, TN 37604-3799

Phone

(423) 534-8897

Fax

(423) 328-8662

NPI assigned

Jul 16, 2008

Last updated

Jan 12, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fairview Therapy

  dba Mini Miracles Pediatric Therapy

  • Early Intervention Provider Agency
  • Johnson City, TN
  • NPI 1831774637
  Medicare reassignment
• Mini Miracles Pediatric Therapy, PLLC

  • Early Intervention Provider Agency
  • Johnson City, TN
  • NPI 1477991560
  NPD (past)

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

{
    "created_epoch": "1216166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421020800000",
    "number": "1194989384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1319 SUNSET DR",
            "address_2": "SUITE 102",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376043799",
            "telephone_number": "423-534-8897",
            "fax_number": "423-328-8662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1319 SUNSET DR",
            "address_2": "SUITE 102",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376043799",
            "telephone_number": "423-534-8897",
            "fax_number": "423-328-8662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKEL",
        "first_name": "COURTNEY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-16",
        "last_updated": "2015-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "PT0000004719",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305206123",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "TN",
            "license": "PT0000004719",
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "VA",
            "license": "2305206123",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Elizabeth Phillips, BSW
• Olivia Blake Phillips
• Angela Phipps
• Physical Therapy Specialists, PLLC
• Jose E Picaza, M.D.
• Ivan Lionel Pickle Jr., LPN
• Andrew S Pierce, MD
• Brandon Nathaniel Pierce, CPHT
• Catherine Jean Pierce, RN
• Tamissa Lashay Pierce, OTR/L

• Pediatric Physical Therapist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Pediatric Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; 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.