NPIMap

Organization Active NPI

Mikrut Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Prescott, AZ
National Provider Identifier
1649223306
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
6486 Issued in AZ
Legal business name
MIKRUT PHYSICAL THERAPY LLC
Practice address
919 12TH PL Ste 11
Prescott, AZ 86305-1433
Phone
(928) 632-0800
Fax
(928) 632-8505
NPI assigned
May 17, 2006
Last updated
Jul 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James Mikrut, PTNPI 1346293248
Title
Owner/President
Phone
(928) 632-0800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 6486 AZ Primary
Physical Therapy Clinic/Center 261QP2000X 5501005426 AZ

Addresses

Primary practice location

919 12TH PL Ste 11
Prescott, AZ 86305-1433

Mailing address

13175 E Highway 169
Dewey, AZ 86327-7372
Phone (928) 632-0800

Other identifiers 1

IdentifierTypeStateIssuer
915936MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050310000698 AZ Part B Supplier - Clinic/Group Practice 1557315678 Receives reassigned benefits from 1 practitioner
Practice locations: Dewey, AZ

National Provider Directory

National Provider Directory

Locations

919 12th Pl
Ste 11
Prescott, AZ 86305
Phone (928) 445-4272

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721865600000",
    "number": "1649223306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13175 E HIGHWAY 169",
            "city": "DEWEY",
            "state": "AZ",
            "postal_code": "863277372",
            "telephone_number": "928-632-0800",
            "fax_number": "928-632-8505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 12TH PL STE 11",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863051433",
            "telephone_number": "928-632-0800",
            "fax_number": "928-632-8505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKRUT PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A",
        "authorized_official_last_name": "MIKRUT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "928-632-0800",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AZ",
            "license": "6486",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "AZ",
            "license": "5501005426",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "915936",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; 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.