Active NPI
Israel Medina, DPT
- Physical Therapist
- Phoenix, AZ
National Provider Identifier
1851626535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 7756
- Practice address
- 15410 S Mountain Pkwy Ste 112
Phoenix, AZ 85044 - Phone
- (480) 689-5509
- NPI assigned
- Oct 13, 2009
- 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 | 7756 | AZ | Primary |
Addresses
Primary practice location
15410 S Mountain Pkwy Ste 112
Phoenix, AZ 85044
Mailing address
2979 E Palmdale LN
Gilbert, AZ 85298-5708
Other practice location 1
1301 E McDowell Rd
Suite 100
Phoenix, AZ 85006-2621
Phone (602) 265-8800
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7756 | AZ | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541980800000",
"number": "1851626535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2979 E PALMDALE LN",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852985708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15410 S MOUNTAIN PKWY STE 112",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "85044",
"telephone_number": "480-689-5509"
}
],
"practiceLocations": [
{
"address_1": "1301 E McDowell Rd",
"address_2": "Suite 100",
"address_purpose": "LOCATION",
"city": "Phoenix",
"state": "AZ",
"postal_code": "850062621",
"country_code": "US",
"telephone_number": "602-265-8800",
"fax_number": "602-265-8151",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MEDINA",
"first_name": "ISRAEL",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-10-13",
"last_updated": "2018-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "7756",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.