Individual provider Active NPI

Laura Muller, P.T.

  • Physical Therapist
  • Port Orange, FL
National Provider Identifier
1508312075
Registry record updated Aug 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 12173 Issued in FL
Practice address
4701 City Center Pkwy
Port Orange, FL 32129-4153
Phone
(386) 304-7660
Fax
(386) 304-7662
NPI assigned
Aug 25, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2016

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 PT 12173 FL Primary

Addresses

Primary practice location

4701 City Center Pkwy
Port Orange, FL 32129-4153

Mailing address

4701 City Center Pkwy
Port Orange, FL 32129-4153
Phone (386) 304-7660

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200408001080 FL Practitioner - Physical Therapist in Private Practice 4587093877 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT 12173FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Health Development Inc CurrentSince Mar 4, 2020 Accepting new patients
Genesis Health Development, Inc. CurrentSince Mar 4, 2020 Accepting new patients
Genesis Health Development, Inc. Past Accepting new patients

Locations

3599 University Blvd S
Jacksonville, FL 32216
Phone (904) 345-7600

4701 City Center Pkwy
Port Orange, FL 32129
Phone (386) 236-7010

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 3

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": "1472083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472083200000",
    "number": "1508312075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 CITY CENTER PKWY",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321294153",
            "telephone_number": "386-304-7660",
            "fax_number": "386-304-7662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 CITY CENTER PKWY",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321294153",
            "telephone_number": "386-304-7660",
            "fax_number": "386-304-7662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLER",
        "first_name": "LAURA",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-25",
        "last_updated": "2016-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 12173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; 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.