Mimzie Attisano, PT
Individual provider Active NPI Physical Therapist · Riverside, OH
NPI 1265857940 · NPPES record last updated Mar 4, 2014
Key facts
- NPI
- 1265857940
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 9840 (OH)
- Practice address
- 4801 Springfield St
Riverside, OH 45431-1084 - Phone
- (937) 236-9965
- NPI assigned
- Mar 4, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9840 | OH | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montgomery County Educational Service Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9840 | OH | Yes |
Addresses
Primary practice location
4801 Springfield St
Riverside, OH 45431-1084
Mailing address
4801 Springfield St
Riverside, OH 45431-1084
Other providers in Riverside, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.