MEDICARE: MYKAELA MARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		CA

General Provider Information

NPI Number	:	1982535704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYKAELA MARTIN

Provider Business Mailing Address
First Line	:	3826 ATASCADERO DRIVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107
Country	:	US
Telephone Number	:	780-318-2058
Fax Number	:

Provider Business Practice Location Address
First Line	:	1828 GARNET AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3352
Country	:	US
Telephone Number	:	858-217-2496
Fax Number	:	888-493-4898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ MYKAELA MARTIN ” Practice Location

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