Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Dr. Mica Peacock, DPT

Individual provider Physical Therapist · NPI 1538831979

Dr. Mica Peacock, DPT is a Physical Therapist in Private Practice in San Rafael, California. Qualified in 2021, 5 years ago. Practices with Stac Physical Therapy Emeryville Inc, an 8-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
5
Licensed in
CA
In the registry since
2021
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

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Practice location Address checks out

1099 D St Ste 105
San Rafael, CA 94901-2839
Phone: (415) 532-8335
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT300982 (CA)

Record details

NPI number1538831979
Entity typeIndividual (Type 1)
GenderFemale
Credentials DPT
Sole proprietorNo
NPI enumeratedOctober 4, 2021
Last updated in NPPESOctober 1, 2022
Certification dateOctober 1, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Stac Physical Therapy Emeryville Inc — 8 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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