Active NPI
Candice Michelson, PHYSICAL THERAPIST
- Geriatric Physical Therapist
- Kodiak, AK
National Provider Identifier
1851613624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 16092
- Practice address
- 1247 Mill Bay Rd
Kodiak, AK 99615-6409 - Phone
- (907) 486-9515
- Fax
- (907) 486-9516
- NPI assigned
- Feb 22, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 16092 | CA | Primary |
Addresses
Primary practice location
1247 Mill Bay Rd
Kodiak, AK 99615-6409
Mailing address
3412 W 187TH PL
Torrance, CA 90504-5831
Phone (310) 999-1937
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 |
|---|---|---|---|
| 16092 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1266796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266796800000",
"number": "1851613624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3412 W 187TH PL",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905045831",
"telephone_number": "310-999-1937",
"fax_number": "310-327-2406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1247 MILL BAY RD",
"city": "KODIAK",
"state": "AK",
"postal_code": "996156409",
"telephone_number": "907-486-9515",
"fax_number": "907-486-9516"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICHELSON",
"first_name": "CANDICE",
"name_prefix": "Mrs.",
"credential": "PHYSICAL THERAPIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-02-22",
"last_updated": "2010-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "CA",
"license": "16092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kodiak, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.