Active NPI
Ryan Slade
- Physical Therapy Assistant
- San Diego, CA
National Provider Identifier
1154860906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 48559
- Practice address
- 235 Nutmeg St
San Diego, CA 92103-6201 - Phone
- (619) 239-8687
- NPI assigned
- Feb 13, 2017
- Sex
- Male
- 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 Therapy Assistant | 225200000X | 48559 | CA | Primary |
Addresses
Primary practice location
235 Nutmeg St
San Diego, CA 92103-6201
Mailing address
6725 Mission Gorge Rd Unit 203B
San Diego, CA 92120-2427
Phone (619) 337-4213
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 |
|---|---|---|---|
| 48559 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486944000000",
"number": "1154860906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6725 MISSION GORGE RD UNIT 203B",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921202427",
"telephone_number": "619-337-4213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 NUTMEG ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921036201",
"telephone_number": "619-239-8687"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SLADE",
"first_name": "RYAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-13",
"last_updated": "2017-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "48559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.