Active NPI
Susan Mitchell, PTGCS
- Physical Therapist
- Annapolis, MD
National Provider Identifier
1235325424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 17650
- Practice address
- 1783 Forest Dr # 307
Annapolis, MD 21401-4229 - Phone
- (571) 208-3099
- Fax
- (443) 569-7464
- NPI assigned
- Sep 20, 2007
- Sex
- Female
- Sole proprietor
- No
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 Therapist | 225100000X | 17650 | MD | Primary |
Addresses
Primary practice location
1783 Forest Dr # 307
Annapolis, MD 21401-4229
Mailing address
1783 Forest Dr # 307
Annapolis, MD 21401-4229
Phone (571) 208-3099
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230321000698 | NY | Practitioner - Physical Therapist in Private Practice | 1456610575 | Practice locations: Potsdam, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17650 | MD | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nourished Life Nutrition, PLLC | Past | Accepting new patients |
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586736000000",
"number": "1235325424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1783 FOREST DR # 307",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214014229",
"telephone_number": "571-208-3099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1783 FOREST DR # 307",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214014229",
"telephone_number": "571-208-3099",
"fax_number": "443-569-7464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "SUSAN",
"credential": "PTGCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-20",
"last_updated": "2020-04-13",
"certification_date": "2020-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "17650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Annapolis, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.