Active NPI
Mary Lydia Engles, PT, MS, OCS
- Orthopedic Physical Therapist
- San Diego, CA
National Provider Identifier
1760447536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- PT6252
- Practice address
- 4120 W Point Loma Blvd
San Diego, CA 92110-5605 - Phone
- (619) 226-4131
- Fax
- (619) 226-4124
- NPI assigned
- Apr 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT6252 | CA | |
| Sports Physical Therapist | 2251S0007X | PT6252 | CA | |
| Orthopedic Physical Therapist | 2251X0800X | PT6252 | CA | Primary |
Addresses
Primary practice location
4120 W Point Loma Blvd
San Diego, CA 92110-5605
Mailing address
4120 W Point Loma Blvd
San Diego, CA 92110-5605
Phone (619) 226-4131
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00PT6252 | Medicaid | CA | |
| 070112 | Other | CA | HEALTH NET PIN NUMBER |
| 00PT62520 | Other | CA | BLUE CROSS PIN NUMBER |
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT6252 | CA | MD | Sports Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280966400000",
"number": "1760447536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4120 W POINT LOMA BLVD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921105605",
"telephone_number": "619-226-4131",
"fax_number": "619-226-4124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4120 W POINT LOMA BLVD",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921105605",
"telephone_number": "619-226-4131",
"fax_number": "619-226-4124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENGLES",
"first_name": "MARY",
"middle_name": "LYDIA",
"name_prefix": "Ms.",
"credential": "PT, MS, OCS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-17",
"last_updated": "2010-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT6252",
"primary": false
},
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": "CA",
"license": "PT6252",
"primary": false
},
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "CA",
"license": "PT6252",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00PT6252",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET PIN NUMBER",
"identifier": "070112",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PIN NUMBER",
"identifier": "00PT62520",
"state": "CA"
}
],
"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 Aug 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.