Mindful Motion Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11909-24 Issued in WI

Legal business name

MINDFUL MOTION PHYSICAL THERAPY, LLC

Practice address

307 S Livingston St
Madison, WI 53703-3513

Phone

(608) 250-1775

NPI assigned

Feb 29, 2012

Organization subpart

No

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

Authorized official

Name

Nathan Dufault, LATNPI 1518243237

Title

Licensed Athletic Trainer

Phone

(608) 250-1775

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jessica Dufault, DPT, ATC

  • Physical Therapist
  • Madison, WI
  • NPI 1245345628
  Medicare reassignment NPD
• Nathan Dufault, ATC, LAT

  • Athletic Trainer
  • Madison, WI
  • NPI 1518243237
  NPD Authorized official

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

{
    "created_epoch": "1330473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626393600000",
    "number": "1366716987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 S LIVINGSTON ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537033513",
            "telephone_number": "608-250-1775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 S LIVINGSTON ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537033513",
            "telephone_number": "608-250-1775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL MOTION PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-29",
        "last_updated": "2021-07-16",
        "certification_date": "2021-07-16",
        "status": "A",
        "authorized_official_last_name": "DUFAULT",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "LICENSED ATHLETIC TRAINER",
        "authorized_official_telephone_number": "608-250-1775",
        "authorized_official_credential": "LAT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "11909-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mind Evolution
• Mind Over Matter
• Dave Minden, PH.D.
• Mindful Growth Psychotherapy, LLC
• Mindful Healing Counseling LLC
• Madelyn L Minnick, APSW
• Nicole Minniti-Bohl, MS, CCC-SLP
• Minor Procedures, S.C.
• Garrett Minor, PT
• William Minser, D. MIN., CSAC

• Physical Therapist in Madison, WI
• Providers in Madison, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.