Provider Demographics
NPI:1447667928
Name:MERCADO, MICHAEL JAMES BELETA (PT, MPT)
Entity type:Individual
Prefix:
First Name:MICHAEL JAMES
Middle Name:BELETA
Last Name:MERCADO
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9020
Mailing Address - Country:US
Mailing Address - Phone:509-668-1214
Mailing Address - Fax:
Practice Address - Street 1:400 PLUMAS BLVD STE 115
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-5081
Practice Address - Country:US
Practice Address - Phone:530-749-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014974225100000X
WAPT60133946225100000X
CA41333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist