Active NPI
Mitchell Crettol
- Physical Therapist
- Fishers, IN
National Provider Identifier
1518786201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05014832A
- Practice address
- 9012 E 126TH St
Fishers, IN 46038-2849 - Phone
- (317) 415-9135
- NPI assigned
- Oct 9, 2024
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05014832A | IN | Primary |
Addresses
Primary practice location
9012 E 126TH St
Fishers, IN 46038-2849
Mailing address
15702 Myland Dr
Noblesville, IN 46062-6497
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 |
|---|---|---|---|
| 05014832A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728432000000",
"number": "1518786201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15702 MYLAND DR",
"city": "NOBLESVILLE",
"state": "IN",
"postal_code": "460626497"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9012 E 126TH ST",
"city": "FISHERS",
"state": "IN",
"postal_code": "460382849",
"telephone_number": "317-415-9135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRETTOL",
"first_name": "MITCHELL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-10-09",
"last_updated": "2024-10-09",
"certification_date": "2024-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05014832A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fishers, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.