Michael Petrak, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

28036 Issued in CA

Practice address

7090 Johnson Dr
Pleasanton, CA 94588-3328

Phone

(925) 227-8555

Fax

(925) 227-8558

NPI assigned

Jul 11, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ida L Coryell HirstGroup PAC ID 5890761514, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ida L Coryell Hirst

  • Physical Therapist
  • Pleasanton, CA
  • NPI 1861494031
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942235684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2296 COUNTRY DR",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945365315",
            "telephone_number": "510-797-9299",
            "fax_number": "510-608-3691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7090 JOHNSON DR",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945883328",
            "telephone_number": "925-227-8555",
            "fax_number": "925-227-8558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRAK",
        "first_name": "MICHAEL",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "28036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0PT280380",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Pestano
• Margaret Ann Petersen, MA, MFT
• Cassy Peterson
• Kelley Parker Peterson, D.C.
• Morgan Peterson
• Judith M Petrick, LMFT
• Patrick Vincent Petti, PH.D.
• Haleh Pezeshkan, M.S. CCC-SLP
• Apoorva Phadke, PT DPT
• Jenny Pham

• Physical Therapist in Pleasanton, CA
• Providers in Pleasanton, CA by specialty
• Physical Therapist in California

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.