MEDICARE: MICHAEL WILLIAM RYMER PT

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	PT16836	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WPT16836A	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1083699169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WILLIAM RYMER PT

Provider Business Mailing Address
First Line	:	200 NEWPORT CENTER DR
Second Line	:	SUITE 213
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7501
Country	:	US
Telephone Number	:	949-644-1322
Fax Number	:	949-644-0316

Provider Business Practice Location Address
First Line	:	2888 LONG BEACH BLVD
Second Line	:	#405
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1530
Country	:	US
Telephone Number	:	562-595-4489
Fax Number	:	562-595-4063

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

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	04/22/2015

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Directions to “ MICHAEL WILLIAM RYMER PT” Practice Location

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