Seaside Performance Physical Therapy, Apc

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

SEASIDE PERFORMANCE PHYSICAL THERAPY, APC

Practice address

6102 Avenida Encinas Ste G
Carlsbad, CA 92011-1005

Phone

(760) 884-0301

Fax

(760) 560-4285

NPI assigned

Oct 25, 2023

Organization subpart

No

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

Authorized official

Name

Mrs. Kaitlin Marie Mikkelsen, DPTNPI 1255879631

Title

Owner

Phone

(858) 717-2621

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kaitlin Marie Mikkelsen, PT, DPT

  • Physical Therapist
  • Carlsbad, CA
  • NPI 1255879631
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1698192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708300800000",
    "number": "1700658408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "754 SNAPDRAGON ST",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920243346",
            "telephone_number": "858-717-2621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6102 AVENIDA ENCINAS STE G",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920111005",
            "telephone_number": "760-884-0301",
            "fax_number": "760-560-4285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEASIDE PERFORMANCE PHYSICAL THERAPY, APC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-25",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A",
        "authorized_official_last_name": "MIKKELSEN",
        "authorized_official_first_name": "KAITLIN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "858-717-2621",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Naudia Betina Scott
• Scripps Health (Scripps Medical Foundation)
• Colleen Tong Seal, PT
• Scott Bradley Seaman, LMFT
• Sean Hassinger MD Inc
• Robert Alexander Seawell, DO
• Michael J Sebahar, M.D.
• Cypress Sechrist
• Benjamin Seth Segales
• Hailey Selburn, MA

• Physical Therapy Clinic/Center in Carlsbad, CA
• Providers in Carlsbad, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.