Samantha Mecklenburg, CMT, HHP, HTPA, CCLS

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

69175 Issued in CA

Practice address

2801 4TH Ave
San Diego, CA 92103-6207

Phone

(619) 363-1569

NPI assigned

Jun 15, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529020800000",
    "number": "1952895724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4873 NIAGARA AVE APT 9",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921076102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 4TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921036207",
            "telephone_number": "619-363-1569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MECKLENBURG",
        "first_name": "SAMANTHA",
        "credential": "CMT, HHP, HTPA, CCLS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-15",
        "last_updated": "2018-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": "69175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mebe Speech and Language Pathology Inc.
• Donald Patrick Mebust, M.D
• James Robert Mebust, DDS
• Mec Services Corp (Home Helpers and Direct Link Office #58847)
• Keyna Mecias
• Gracie Erin Mecum
• Lauren Mecum
• Med Fit Consulting, Inc.
• Med Fit Management Group LLC
• Med Info Service, Inc.

• Massage Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Massage Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.

Verify at the official NPI Registry.