Active NPI
Samuel Edward Mieske, M.P.T.
- Physical Therapist
- Fullerton, CA
National Provider Identifier
1720295116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 30451
- Practice address
- 2000 E Chapman Ave Ste 100
Fullerton, CA 92831-4106 - Phone
- (714) 870-1744
- NPI assigned
- May 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 30451 | CA | Primary |
Addresses
Primary practice location
2000 E Chapman Ave Ste 100
Fullerton, CA 92831-4106
Mailing address
500 Ximeno Ave Apt 224
Long Beach, CA 90814-4509
Phone (562) 856-7640
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30451 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720295116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 XIMENO AVE APT 224",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908144509",
"telephone_number": "562-856-7640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 E CHAPMAN AVE STE 100",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928314106",
"telephone_number": "714-870-1744"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIESKE",
"first_name": "SAMUEL",
"middle_name": "EDWARD",
"credential": "M.P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "30451",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.