Individual ProviderChad David MediatePhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address4130 La Jolla Village Dr, Suite 306, La Jolla, CA 92037-9121(858) 455-6460(216) 272-0558PECOS EnrollmentBased on the most recent information from CMS, provider Chad David Mediate does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1265702807Provider TypeIndividualFull NameMediate, Chad DavidTitleDr.CredentialD.P.T.GenderMaleSole ProprietorNoEnumeration Date1/12/2012Last Updated1/12/2012Contact InformationPractice LocationPractice Address4130 La Jolla Village Dr, Suite 306, La Jolla, CA 92037-9121Phone(858) 455-6460FaxUnlisted FaxMailing LocationMailing Address3651 1/2 Arnold Ave, 1/2, San Diego, CA 92104-3441Phone(216) 272-0558FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense37003CaliforniaCode225100000XDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense012196Ohio