Active NPI
Ryan Mitchell, PTA
- Physical Therapy Assistant
- Davison, MI
National Provider Identifier
1629660535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5502005419
- Practice address
- 3058 N State Rd Ste E
Davison, MI 48423-3508 - Phone
- (810) 652-6315
- Fax
- (810) 652-6213
- NPI assigned
- Feb 11, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 12089 | MI | |
| Physical Therapy Assistant | 225200000X | 5502005419 | MI | Primary |
Addresses
Primary practice location
3058 N State Rd Ste E
Davison, MI 48423-3508
Mailing address
5825 Mill St
Clarkston, MI 48346-3363
Phone (810) 282-1345
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 |
|---|---|---|---|
| 5502005419 | MI | MD | Physical Therapy Assistant |
| 12089 | MI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614902400000",
"number": "1629660535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5825 MILL ST",
"city": "CLARKSTON",
"state": "MI",
"postal_code": "483463363",
"telephone_number": "810-282-1345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3058 N STATE RD STE E",
"city": "DAVISON",
"state": "MI",
"postal_code": "484233508",
"telephone_number": "810-652-6315",
"fax_number": "810-652-6213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "RYAN",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-02-11",
"last_updated": "2021-03-05",
"certification_date": "2021-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "12089",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MI",
"license": "5502005419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davison, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.