Ethan Mix, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P17497 Issued in NC

Practice address

445 S Kings Dr
Charlotte, NC 28204-3041

Phone

(704) 384-1737

NPI assigned

Nov 3, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: emix508679@direct.novanthealth.org

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

{
    "created_epoch": "1446508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1295108090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-510-8000",
            "fax_number": "704-510-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 S KINGS DR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043041",
            "telephone_number": "704-384-1737"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "92 West Ave",
            "address_purpose": "LOCATION",
            "city": "Brockport",
            "state": "NY",
            "postal_code": "144201306",
            "country_code": "US",
            "telephone_number": "585-637-0790",
            "fax_number": "585-637-3572",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10810 Mallard Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282629786",
            "country_code": "US",
            "telephone_number": "704-510-8000",
            "fax_number": "704-510-8006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIX",
        "first_name": "ETHAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-03",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "039525-1",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P17497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "EMIX508679@DIRECT.NOVANTHEALTH.ORG",
            "affiliation": "N",
            "address_1": "10810 Mallard Creek Rd",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282629786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dana M Mittag, MS, CGC
• Sushil Chander Mittal, M.D.
• Amrutha Sai Mittapalli, MD
• Robert L. Mittl Jr., M.D.
• Valerie Finfrock Mittl, PH.D.
• Jennifer E Mixter, P.A.
• Jordan Tyler Mizell, MD
• Mackenzie Mizell, MA
• Mja Enterprises Inc.
• Diana N Mjalli

• Physical Therapist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.