Active NPI
Jonathan M Mendicelli, PTA
- Physical Therapy Assistant
- Holland, MI
National Provider Identifier
1225658123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5502006160
- Practice address
- 280 W 40TH St
Holland, MI 49423-4664 - Phone
- (616) 796-3600
- NPI assigned
- Apr 21, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5502006160 | MI | Primary |
Addresses
Primary practice location
280 W 40TH St
Holland, MI 49423-4664
Mailing address
18256 Swiss Dr Apt 16
Spring Lake, MI 49456-9741
Phone (231) 878-7161
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5502006160 | MI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1587427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587427200000",
"number": "1225658123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18256 SWISS DR APT 16",
"city": "SPRING LAKE",
"state": "MI",
"postal_code": "494569741",
"telephone_number": "231-878-7161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "280 W 40TH ST",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494234664",
"telephone_number": "616-796-3600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDICELLI",
"first_name": "JONATHAN",
"middle_name": "M",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-21",
"last_updated": "2020-04-21",
"certification_date": "2020-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MI",
"license": "5502006160",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.