Individual provider Active NPI

Renee Stetkevich, PT

  • Physical Therapist
  • San Diego, CA
National Provider Identifier
1538357397
Registry record updated Jan 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
B7908519 Issued in CA
Practice address
9333 Genesee Ave
Suite 150
San Diego, CA 92121-2111
Phone
(858) 453-3000
Fax
(858) 456-3066
NPI assigned
Oct 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X B7908519 CA Primary

Addresses

Primary practice location

9333 Genesee Ave
Suite 150
San Diego, CA 92121-2111

Mailing address

9333 Genesee Ave
Suite 150
San Diego, CA 92121-2111
Phone (858) 453-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120125000056 CA Practitioner - Physical Therapist in Private Practice 8820265325 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Columbia University College of Physicians and Surgeons, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Es3 Physical Therapy IncGroup PAC ID 2365859550, 5 clinicians

Practice addresses (Care Compare)

10425 Tierrasanta Blvd
Suite 102
San Diego, CA 92124-2618
Phone (858) 598-5055

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
33878CAMDChiropractor
B7908519CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Es3 Physical Therapy Inc CurrentSince Feb 1, 2021 Accepting new patients

Locations

10425 Tierrasanta Blvd
Ste 102
San Diego, CA 92124
Phone (858) 598-5055

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327881600000",
    "number": "1538357397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9333 GENESEE AVE",
            "address_2": "SUITE 150",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212111",
            "telephone_number": "858-453-3000",
            "fax_number": "858-456-3066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9333 GENESEE AVE",
            "address_2": "SUITE 150",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212111",
            "telephone_number": "858-453-3000",
            "fax_number": "858-456-3066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STETKEVICH",
        "first_name": "RENEE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-05",
        "last_updated": "2012-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "B7908519",
            "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 Jan 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.