Active NPI
Marit Mikkelsen, DPT
- Physical Therapist
- Oceanside, CA
National Provider Identifier
1679121636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070024725
- Practice address
- 200 Mercy Circle
1St Floor
Oceanside, CA 92055-5191 - Phone
- (760) 719-3382
- NPI assigned
- Sep 3, 2019
- Last updated
- Oct 18, 2024
- Sex
- Female
- 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 | 070024725 | IL | Primary |
Addresses
Primary practice location
200 Mercy Circle
1St Floor
Oceanside, CA 92055-5191
Mailing address
PO Box 555191
Camp Pendleton, CA 92055-5191
Phone (760) 719-3382
Other practice location 1
555 Busse Hwy Unit 1C
Park Ridge, IL 60068-3189
Phone (877) 632-6637
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 |
|---|---|---|---|
| 070024725 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthomidwest, PLLC | Physical Therapist | Current | Accepting new patients |
Locations
770 Beloit Rd
Belvidere, IL 61008
Phone (815) 847-7060
555 Busse Hwy
Unit 1C
Park Ridge, IL 60068
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729209600000",
"number": "1679121636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 555191",
"city": "CAMP PENDLETON",
"state": "CA",
"postal_code": "920555191",
"telephone_number": "760-719-3382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MERCY CIRCLE",
"address_2": "1ST FLOOR",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "920555191",
"telephone_number": "760-719-3382"
}
],
"practiceLocations": [
{
"address_1": "555 Busse Hwy Unit 1C",
"address_purpose": "LOCATION",
"city": "Park Ridge",
"state": "IL",
"postal_code": "600683189",
"country_code": "US",
"telephone_number": "877-632-6637",
"fax_number": "708-409-5179",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MIKKELSEN",
"first_name": "MARIT",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-03",
"last_updated": "2024-10-18",
"certification_date": "2024-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070024725",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oceanside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.