Active NPI
John Raymond Mikula Jr., CTRS
- Recreation Therapist
- Memphis, TN
National Provider Identifier
1437190279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 43701
- Practice address
- 1030 Jefferson Ave
Memphis, TN 38104-2127 - Phone
- (901) 523-8990
- NPI assigned
- Jun 10, 2006
- Last updated
- Feb 11, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 43701 | TN | Primary |
Addresses
Primary practice location
1030 Jefferson Ave
Memphis, TN 38104-2127
Mailing address
374 Silverthorn Dr NW
Marietta, GA 30064
Phone (352) 246-2124
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43701 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455148800000",
"number": "1437190279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "374 SILVERTHORN DR NW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30064",
"telephone_number": "352-246-2124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 JEFFERSON AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381042127",
"telephone_number": "901-523-8990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKULA",
"first_name": "JOHN",
"middle_name": "RAYMOND",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "CTRS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-10",
"last_updated": "2016-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "TN",
"license": "43701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.