Active NPI
Breck Alan Mitchell, PT, DPT
- Physical Therapist
- Webb City, MO
National Provider Identifier
1629670328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2020037945
- Practice address
- 501 S Madison St Ste L
Webb City, MO 64870-2426 - Phone
- (417) 673-2156
- Fax
- (417) 673-2176
- NPI assigned
- Nov 9, 2020
- 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 | 2020037945 | MO | Primary |
Addresses
Primary practice location
501 S Madison St Ste L
Webb City, MO 64870-2426
Mailing address
1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 238-7217
Other practice location 1
320 E Austin Blvd
Nevada, MO 64772-3408
Phone (417) 667-6673
Other practice location 2
1010 S Madison St Ste F
Webb City, MO 64870-2501
Phone (417) 673-0600
Other practice location 3
4830 E 32nd St Ste 3
Joplin, MO 64804-4420
Phone (417) 781-0082
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2020037945 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624579200000",
"number": "1629670328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 CORPORATE DR STE 400",
"city": "HOOVER",
"state": "AL",
"postal_code": "352425424",
"telephone_number": "423-238-7217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 S MADISON ST STE L",
"city": "WEBB CITY",
"state": "MO",
"postal_code": "648702426",
"telephone_number": "417-673-2156",
"fax_number": "417-673-2176"
}
],
"practiceLocations": [
{
"address_1": "320 E Austin Blvd",
"address_purpose": "LOCATION",
"city": "Nevada",
"state": "MO",
"postal_code": "647723408",
"country_code": "US",
"telephone_number": "417-667-6673",
"fax_number": "417-667-7733",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1010 S Madison St Ste F",
"address_purpose": "LOCATION",
"city": "Webb City",
"state": "MO",
"postal_code": "648702501",
"country_code": "US",
"telephone_number": "417-673-0600",
"fax_number": "417-673-0601",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4830 E 32nd St Ste 3",
"address_purpose": "LOCATION",
"city": "Joplin",
"state": "MO",
"postal_code": "648044420",
"country_code": "US",
"telephone_number": "417-781-0082",
"fax_number": "417-781-2893",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MITCHELL",
"first_name": "BRECK",
"middle_name": "ALAN",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-09",
"last_updated": "2021-06-25",
"certification_date": "2021-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2020037945",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Webb City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.