Provider Demographics
NPI:1831838820
Name:PUBLICO, MYKA KRISTINE
Entity type:Individual
Prefix:
First Name:MYKA
Middle Name:KRISTINE
Last Name:PUBLICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYKA
Other - Middle Name:
Other - Last Name:PERUSEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-0749
Mailing Address - Country:US
Mailing Address - Phone:704-869-2088
Mailing Address - Fax:980-288-4239
Practice Address - Street 1:16409 NORTHCROSS DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5065
Practice Address - Country:US
Practice Address - Phone:980-441-8200
Practice Address - Fax:980-441-8202
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist