Mitchell Griffin Fornecker, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

P19356 Issued in NC

Practice address

11030 Raven Ridge Rd Ste 101
Raleigh, NC 27614-8512

Phone

(919) 844-6611

NPI assigned

Mar 8, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Abilitations Children'S Therapy & Wellness Center

  • Physical Therapist
  • Raleigh, NC
  • NPI 1356510945
  NPD (past)

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

{
    "created_epoch": "1583625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583625600000",
    "number": "1881229060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11030 RAVEN RIDGE RD STE 101",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148512",
            "telephone_number": "919-844-6611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11030 RAVEN RIDGE RD STE 101",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148512",
            "telephone_number": "919-844-6611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNECKER",
        "first_name": "MITCHELL",
        "middle_name": "GRIFFIN",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-08",
        "last_updated": "2020-03-08",
        "certification_date": "2020-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P19356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacie Anne Foresi, PA-C
• Jessica Ann Forestier, DDS
• Carla F Forestieri, CCC-A
• Byron Keith Forgy, M.D.
• Fatima Alimatu Fornah, CRNA
• Megan Forrest
• Stacie Creech Forrest, LPC
• Sandra Forrester
• Cynthia Forsley, LCSWA
• Micah Forsline

• Physical Therapist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.