Healthcare Provider Details

I. General information

NPI: 1992335954
Provider Name (Legal Business Name): MITCHELL J POPIELEC PT, DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2020
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 NJ-27 SUITE 1B
KENDALL PARK NJ
08824
US

IV. Provider business mailing address

118 VICTORY RD APT 141
SPRINGFIELD NJ
07081-1338
US

V. Phone/Fax

Practice location:
  • Phone: 757-633-7045
  • Fax:
Mailing address:
  • Phone: 757-633-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA02169600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217656
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: