Active NPI
Renee Micek, P.T.
- Physical Therapist
- Glendale, AZ
National Provider Identifier
1285856807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2075
- Practice address
- 5405 W. Kerry Lane
Glendale, AZ 85308-4952 - Phone
- (623) 362-3380
- NPI assigned
- May 3, 2007
- Last updated
- Sep 28, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 Therapist | 225100000X | 2075 | AZ | Primary |
Addresses
Primary practice location
5405 W. Kerry Lane
Glendale, AZ 85308-4952
Mailing address
5405 W. Kerry Lane
Glendale, AZ 85308-4952
Phone (623) 362-3380
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2075 | AZ | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Killeen Therapy Services, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Rehabilitation Practitioner
- Glendale, AZ
- NPI 1164455531
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285632000000",
"number": "1285856807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5405 W. KERRY LANE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853084952",
"telephone_number": "623-362-3380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5405 W. KERRY LANE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853084952",
"telephone_number": "623-362-3380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICEK",
"first_name": "RENEE",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-03",
"last_updated": "2010-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "2075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.