Michelle M Theis-Black, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

49327 Issued in CA

Practice address

2730 Wilshire Blvd Ste 533
Santa Monica, CA 90403-4751

Phone

(310) 828-0101

NPI assigned

May 22, 2018

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1526947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526947200000",
    "number": "1679064927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9129 NATIONAL BLVD APT 5",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900348534",
            "telephone_number": "614-354-6268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2730 WILSHIRE BLVD STE 533",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904034751",
            "telephone_number": "310-828-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEIS-BLACK",
        "first_name": "MICHELLE",
        "middle_name": "M",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-22",
        "last_updated": "2018-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "49327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Regents of the University of California
• The Regents of the University of California
• The Regents of the University of California
• The Saturday Center for Psychotherapy and Training
• Nicolette Theard, PT
• Walter Kurt Theis II, M.D.
• Therapeutic Arts Marriage and Family Therapy, Inc.
• Therapy Place 4 Kids
• Therapy Place, P.C.
• Erika Thiede, RDN

• Physical Therapy Assistant in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; 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.