Provider Demographics
NPI:1871773200
Name:PODLENSKI, MICHAEL (PTA, ATC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PODLENSKI
Suffix:
Gender:M
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 FUERTE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3739
Mailing Address - Country:US
Mailing Address - Phone:619-441-0192
Mailing Address - Fax:619-441-0193
Practice Address - Street 1:8881 FLETCHER PKWY
Practice Address - Street 2:SUITE #280
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3134
Practice Address - Country:US
Practice Address - Phone:619-464-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT2570225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant