Individual provider Active NPI

Amanda R Mitchell, PT, DPT

  • Physical Therapist
  • Venice, FL
National Provider Identifier
1356941371
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT36164 Issued in FL
Practice address
3030 Executive Dr
Venice, FL 34292-2613
Phone
(941) 485-1505
Fax
(941) 485-7495
NPI assigned
Oct 28, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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 PT36164 FL Primary

Addresses

Primary practice location

3030 Executive Dr
Venice, FL 34292-2613

Mailing address

3030 Executive Dr
Venice, FL 34292-2613
Phone (941) 485-1505

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201105000864 FL Practitioner - Physical Therapist in Private Practice 4385054121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Suncoast Orthopaedic Surgery and Sports Medicine, P.a.Group PAC ID 0648296285, 14 clinicians

Practice addresses (Care Compare)

3030 Executive Dr
Venice, FL 34292-2613
Phone (941) 485-1505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Suncoast Orthopaedic Surgery & Sports Medicine, P.a. CurrentSince Aug 1, 2023 Accepting new patients

Locations

3030 Executive Dr
Venice, FL 34292
Phone (941) 485-1505

836 Sunset Lake Blvd
Ste 205A
Venice, FL 34292
Phone (941) 485-1505

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": "1603843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1356941371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 EXECUTIVE DR",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342922613",
            "telephone_number": "941-485-1505",
            "fax_number": "941-485-7495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 EXECUTIVE DR",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342922613",
            "telephone_number": "941-485-1505",
            "fax_number": "941-485-7495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "AMANDA",
        "middle_name": "R",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-28",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT36164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; 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.