Active NPI
Mackenzie Gould
- Physical Therapy Assistant
- Plant City, FL
National Provider Identifier
1255084083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 31697
- Practice address
- 621 E Alexander St FL 33563
Plant City, FL 33563-7126 - Phone
- (813) 707-1509
- NPI assigned
- Feb 1, 2022
- 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 Therapy Assistant | 225200000X | 31697 | FL | Primary |
Addresses
Primary practice location
621 E Alexander St FL 33563
Plant City, FL 33563-7126
Mailing address
5006 Twin Pine Dr
Plant City, FL 33566-7977
Phone (813) 751-7846
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12345 | Medicaid | FL |
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 |
|---|---|---|---|
| 31697 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1643673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643673600000",
"number": "1255084083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5006 TWIN PINE DR",
"city": "PLANT CITY",
"state": "FL",
"postal_code": "335667977",
"telephone_number": "813-751-7846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 E ALEXANDER ST FL 33563",
"city": "PLANT CITY",
"state": "FL",
"postal_code": "335637126",
"telephone_number": "813-707-1509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOULD",
"first_name": "MACKENZIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-02-01",
"last_updated": "2022-02-01",
"certification_date": "2022-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "31697",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "12345",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plant City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.