Active NPI
Jenna Mixon, DPT
- Physical Therapist
- Cicero, IL
National Provider Identifier
1861983777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 14163-24
- Practice address
- 5110 W 24TH St
Cicero, IL 60804-2948 - Phone
- (847) 364-2435
- NPI assigned
- May 25, 2018
- 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 | 14163-24 | WI | Primary |
Addresses
Primary practice location
5110 W 24TH St
Cicero, IL 60804-2948
Mailing address
12 Harrison St
Oak Park, IL 60304-1771
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 |
|---|---|---|---|
| 14163-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663718400000",
"number": "1861983777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 HARRISON ST",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603041771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5110 W 24TH ST",
"city": "CICERO",
"state": "IL",
"postal_code": "608042948",
"telephone_number": "847-364-2435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIXON",
"first_name": "JENNA",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-25",
"last_updated": "2022-09-21",
"certification_date": "2022-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "14163-24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cicero, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.