Active NPI
Joann Dawn Mix, PT
- Physical Therapist
- Belleville, IL
National Provider Identifier
1255681888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11-05712
- Practice address
- 1201 Hartman LN
Belleville, IL 62221-8402 - Phone
- (618) 207-1610
- NPI assigned
- Sep 11, 2012
- 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 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070018003 | IL | |
| Physical Therapist | 225100000X | 40QA00986500 | NJ | |
| Physical Therapist | 225100000X | 2010006857 | MO | |
| Physical Therapist | 225100000X | PT-3992 | HI | |
| Physical Therapist | 225100000X | PTH7173 | AL | |
| Physical Therapist | 225100000X | PT011528 | GA | |
| Physical Therapist | 225100000X | 40574 | CA | |
| Physical Therapist | 225100000X | 11-05712 | KS | Primary |
Addresses
Primary practice location
1201 Hartman LN
Belleville, IL 62221-8402
Mailing address
1201 Hartman LN
Belleville, IL 62221-8402
Phone (618) 207-1610
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 |
|---|---|---|---|
| PTH7173 | AL | MD | Physical Therapist |
| PT011528 | GA | MD | Physical Therapist |
| PT-3992 | HI | MD | Physical Therapist |
| 070018003 | IL | MD | Physical Therapist |
| 11-05712 | KS | MD | Physical Therapist |
| 2010006857 | MO | MD | Physical Therapist |
| 40QA00986500 | NJ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522627200000",
"number": "1255681888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 HARTMAN LN",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622218402",
"telephone_number": "618-207-1610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 HARTMAN LN",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622218402",
"telephone_number": "618-207-1610"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIX",
"first_name": "JOANN",
"middle_name": "DAWN",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-11",
"last_updated": "2018-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070018003",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NJ",
"license": "40QA00986500",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2010006857",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "HI",
"license": "PT-3992",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AL",
"license": "PTH7173",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT011528",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "40574",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KS",
"license": "11-05712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.