Mary K Popylisen, PT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

80680 Issued in CA

Practice address

2222 Bancroft Ext
Berkeley, CA 94720-4300

Phone

(510) 642-5651

Fax

(510) 643-5079

NPI assigned

May 24, 2007

Last updated

Sep 11, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1245441237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4436 HYACINTH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946192816",
            "telephone_number": "510-482-5510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 BANCROFT EXT",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947204300",
            "telephone_number": "510-642-5651",
            "fax_number": "510-643-5079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POPYLISEN",
        "first_name": "MARY",
        "middle_name": "K",
        "credential": "PT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-24",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "16912",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": "80680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Pon
• Carlos Alberto Ponce, LMFT
• Isabel Ponte
• Pardis Poorzand, M.D.
• Bobby Pope
• Judy Porat
• Bryan B. Port, PSY.D.
• Angela Gabriel Porter, MA, RAS
• Raymond Porter
• Elizabeth Brodsky Portin, DO

• Athletic Trainer in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Athletic Trainer in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.