Nilisha Mikklineni, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 35459 Issued in CA

Practice address

594 Myrtle Beach Dr
Brentwood, CA 94513-5617

Phone

(408) 821-7786

NPI assigned

Jun 2, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1376863290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "594 MYRTLE BEACH DR",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945135617",
            "telephone_number": "408-821-7786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "594 MYRTLE BEACH DR",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945135617",
            "telephone_number": "408-821-7786"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2039 Forest Ave",
            "address_2": "#104",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951284817",
            "country_code": "US",
            "telephone_number": "408-279-8501",
            "fax_number": "408-279-8504",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6101 Bollinger Canyon Rd Ste 381",
            "address_purpose": "LOCATION",
            "city": "San Ramon",
            "state": "CA",
            "postal_code": "945835118",
            "country_code": "US",
            "telephone_number": "408-821-7786",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIKKLINENI",
        "first_name": "NILISHA",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-02",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 35459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Brentwood, CA
• Providers in Brentwood, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; 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.