Active NPI
Jeanette Micelotta, PT
- Physical Therapist
- Jacksonville, FL
National Provider Identifier
1497781132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT11125
- Practice address
- 12421 San Jose Blvd
Suite 100
Jacksonville, FL 32223-2680 - Phone
- (904) 292-0195
- Fax
- (904) 292-0566
- NPI assigned
- Jun 24, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT11125 | FL | Primary |
Addresses
Primary practice location
12421 San Jose Blvd
Suite 100
Jacksonville, FL 32223-2680
Mailing address
12421 San Jose Blvd
Suite 100
Jacksonville, FL 32223-2680
Phone (904) 292-0195
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Atlas Physical Therapy & Sports Medicine Inc | Physical Therapist | Current | Accepting new patients |
| Sale Therapy Inc | Physical Therapist | Past | Accepting new patients |
Locations
12421 San Jose Blvd
Ste 100
Jacksonville, FL 32223
Phone (904) 292-0195
Organizations & group practices 2
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.
-
- Physical Therapist
- St Augustine, FL
- NPI 1184214546
-
- Physical Therapist
- Atlantic Beach, FL
- NPI 1124249313
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497781132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12421 SAN JOSE BLVD",
"address_2": "SUITE 100",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322232680",
"telephone_number": "904-292-0195",
"fax_number": "904-292-0566"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12421 SAN JOSE BLVD",
"address_2": "SUITE 100",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322232680",
"telephone_number": "904-292-0195",
"fax_number": "904-292-0566"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICELOTTA",
"first_name": "JEANETTE",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT11125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.