Individual ProviderMichelle Lynn MedickePhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address7946 Ivanhoe Ave Ste 110, La Jolla, CA 92037-4516(858) 551-8882(951) 837-5796PECOS EnrollmentBased on the most recent information from CMS, provider Michelle Lynn Medicke 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 ID1417529447Provider TypeIndividualFull NameMedicke, Michelle LynnCredentialDPTGenderFemaleSole ProprietorYesEnumeration Date7/9/2021Last Updated7/9/2021Contact InformationPractice LocationPractice Address7946 Ivanhoe Ave Ste 110, La Jolla, CA 92037-4516Phone(858) 551-8882FaxUnlisted FaxMailing LocationMailing Address29925 Corte Tolano, Temecula, CA 92591-5327Phone(951) 837-5796FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense295856California