NPIMap

Individual provider Active NPI

Michele E Pena, P.T.

  • Physical Therapist
  • San Antonio, TX
National Provider Identifier
1992971899
Registry record updated Apr 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1179690 Issued in TX
Practice address
2203 Babcock Rd
San Antonio, TX 78229-4412
Phone
(210) 614-3911
Fax
(210) 616-0043
NPI assigned
May 1, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1179690 TX Primary

Addresses

Primary practice location

2203 Babcock Rd
San Antonio, TX 78229-4412

Mailing address

2203 Babcock Rd
San Antonio, TX 78229-4412
Phone (210) 614-3911

Other identifiers 2

IdentifierTypeStateIssuer
1992971899MedicaidTX
1179690OtherTXLICENSE

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

LicenseStateTypeSpecialty
1179690TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jem Physical Therapy & Sports Medicine, PLLC Physical Therapist Current Accepting new patients
US Health Facilities Development Physical Therapist Past Accepting new patients
US Health Facilities Development Past Accepting new patients
Physical Therapy Providers, Inc. Physical Therapist Past Accepting new patients

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1992971899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2203 BABCOCK RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294412",
            "telephone_number": "210-614-3911",
            "fax_number": "210-616-0443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2203 BABCOCK RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294412",
            "telephone_number": "210-614-3911",
            "fax_number": "210-616-0043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "MICHELE",
        "middle_name": "E",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-01",
        "last_updated": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1179690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992971899",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "1179690",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; 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.