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General NPI Number Information
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NPI Number | 1447667928
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Entity Type | Individual
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Provider Name | MICHAEL JAMES BELETA MERCADO PT, MPT
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Gender | Male
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 400 PLUMAS BLVD STE 115
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City | YUBA CITY
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State | CA
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Zip | 95991-5081
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Country | US
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Telephone | 530-749-3450
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Fax |
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Provider Business Mailing Address
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Address Line | 3009 MARKET ST
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City | ROSEVILLE
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State | CA
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Zip | 95747-9020
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Country | US
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Telephone | 509-668-1214
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501014974
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60133946
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 41333
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License Number State | CA
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