Michelle Lynn Medicke, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

295856 Issued in CA

Practice address

7946 Ivanhoe Ave Ste 110
La Jolla, CA 92037-4516

Phone

(858) 551-8882

NPI assigned

Jul 9, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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": "1625788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625788800000",
    "number": "1417529447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29925 CORTE TOLANO",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925915327",
            "telephone_number": "951-837-5796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7946 IVANHOE AVE STE 110",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920374516",
            "telephone_number": "858-551-8882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDICKE",
        "first_name": "MICHELLE",
        "middle_name": "LYNN",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-09",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "295856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://creamerphysicaltherapy.com/",
            "affiliation": "N",
            "address_1": "7946 Ivanhoe Ave Ste 110",
            "city": "LA Jolla",
            "state": "CA",
            "country_code": "US",
            "postal_code": "920374516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Charles Mears
• Medaid Center
• Anthony J Medak, MD
• Fernando Mediano
• Chad David Mediate, D.P.T.
• Medihelp24
• Andrew Shou Medina
• Aysell Medina
• Janice Medina, CNS
• Gregory Daniel Medley, PHARM. D.

• Physical Therapist in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; 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.