Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mikenzi Pettenger, PT, DPT

Individual provider Physical Therapist · NPI 1093520850

Mikenzi Pettenger, PT, DPT is a Physical Therapist in Private Practice in Daytona Beach, Florida. Qualified in 2024, 2 years ago. Practices with Premier Wellness Centers LLC, a 4-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Florida.

Years since qualifying
2
Licensed in
FL
In the registry since
2025
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

1865 Lpga Blvd
Daytona Beach, FL 32117-7108
Phone: (386) 258-4596
Fax: (386) 258-3561
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT42809 (FL)

Record details

NPI number1093520850
Entity typeIndividual (Type 1)
GenderFemale
Credentials PT , DPT
Sole proprietorNo
NPI enumeratedFebruary 10, 2025
Last updated in NPPESFebruary 10, 2025
Certification dateFebruary 10, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Premier Wellness Centers Llc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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