Martina N/a Mikulic, DPT
Individual provider Active NPI Physical Therapist · Willard, MO
NPI 1659040269 · NPPES record last updated Jul 15, 2024
Key facts
- NPI
- 1659040269
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2024025501 (MO)
- Practice address
- 304 E Jackson St Ste 2F
Willard, MO 65781-9472 - Phone
- (417) 221-4667
- NPI assigned
- Sep 8, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2024025501 | MO | MD | Physical Therapist |
| PT029692 | PA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pivot Physical Therapy of Pennsylvania, LLC | Physical Therapist | Current |
Accepting new patients |
| Willard Physical Therapy Center LLC | Physical Therapist | Current |
Accepting new patients |
| Procare Physical Therapy Inc | Physical Therapist | Past | Accepting new patients |
| Dynamic Therapy Services, LLC | Physical Therapist | Past | Accepting new patients |
Locations
304 E Jackson St
Ste 2F
Willard, MO 65781
Phone (417) 221-4667
350 New Fidelity Ct
Garner, NC 27529
Phone (919) 373-2919
106 S Hanover St
Hummelstown, PA 17036
Phone (717) 566-6000
6455 Carlisle Pike
Ste 2
Mechanicsburg, PA 17050
Phone (717) 802-8767
655 Northern Blvd
South Abington Township, PA 18411
Phone (570) 587-2142
130 W Main St
Ste 100B
Trappe, PA 19426
Phone (484) 471-6850
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT029692 | PA | |
| Physical Therapist | 225100000X | 2024025501 | MO | Yes |
Addresses
Primary practice location
304 E Jackson St Ste 2F
Willard, MO 65781-9472
Mailing address
PO Box 257
Willard, MO 65781-0257
Phone (417) 221-4667
Other providers in Willard, MO
- Mollie R Leek
- Carly Lenzen
- Lester E Cox Medical Centers
- Lester E. Cox Medical Centers
- Hannah Lynn Littlepage
- Rachel Milburn
- Rebecca Jean Mooney
- N & R of Willard LLC
- Katelyn Nash
- Justin Tom Nguyen
All providers in Willard, MO · Physical Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.