Immanuel Karlo Galleta Medina, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

299318 Issued in CA

Practice address

8758 Welles Edge Dr
San Antonio, TX 78240

Phone

(408) 449-8150

NPI assigned

Oct 2, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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": "1349136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1770834665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8758 WELLES EDGE DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782402115",
            "telephone_number": "408-449-8150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8758 WELLES EDGE DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78240",
            "telephone_number": "408-449-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "IMMANUEL KARLO",
        "middle_name": "GALLETA",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-02",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "TX",
            "license": "1217753",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "299318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMV",
            "identifier": "36289166",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elvira Basanes Medina
• Ernest Medina Jr., PHARM.D.
• Ester Yvonne Medina I, RBT
• Gilbert Arthur Medina, M.D.
• Hector Medina
• Josue A. Medina, MD
• Kassandra Anylu Medina
• Kayla Nyree Medina
• Klaudia Jazmin Medina, LCSW
• Leonida Marquez Medina

• Physical Therapist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; 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.