Provider Demographics
NPI:1790853752
Name:PICKERING, JOY (MPT)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:PICKERING
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 CHILDREN'S WAY MC 5068
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-966-5829
Mailing Address - Fax:858-966-5859
Practice Address - Street 1:3020 CHILDREN'S WAY MC 5068
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-966-5829
Practice Address - Fax:858-966-5859
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT25166AMedicare ID - Type UnspecifiedPT PROVIDER NUMBER