Individual provider Active NPI

Virginia Mottla, PT, DPT, CSCS

  • Physical Therapist
  • New York, NY
National Provider Identifier
1285595249
Registry record updated Nov 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
055269 Issued in NY
Practice address
1317 3Rd Ave FL 9
New York, NY 10021-2963
Phone
(212) 439-1596
NPI assigned
Nov 19, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 055269 NY Primary

Addresses

Primary practice location

1317 3Rd Ave FL 9
New York, NY 10021-2963

Mailing address

3806 20TH Rd
Astoria, NY 11105-1626
Phone (617) 633-4144

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251215002127 NY Practitioner - Physical Therapist in Private Practice 6103310362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
New York University School of Medicine, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Evolve Physical Therapy, PLLCGroup PAC ID 2668644527, 14 clinicians

Practice addresses (Care Compare)

1317 3Rd Ave
FL 9
New York, NY 10021-2963
Phone (212) 439-1596

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
055269NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Evolve Physical Therapy, PLLC Physical Therapist CurrentSince Nov 12, 2025 Accepting new patients

Locations

1317 3rd Ave
Fl 9
New York, NY 10021
Phone (212) 439-1596

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1763510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763510400000",
    "number": "1285595249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3806 20TH RD",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111051626",
            "telephone_number": "617-633-4144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 3RD AVE FL 9",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100212963",
            "telephone_number": "212-439-1596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOTTLA",
        "first_name": "VIRGINIA",
        "credential": "PT, DPT, CSCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-11-19",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "055269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.