MEDICARE: MRS. CAROL CHRISTINE MAIOLFI III 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	7149	CA

General Provider Information

NPI Number	:	1093794919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL CHRISTINE MAIOLFI III PT

Provider Business Mailing Address
First Line	:	4872 CANDLEBERRY AVE
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-3058
Country	:	US
Telephone Number	:	562-225-5633
Fax Number	:	562-596-6901

Provider Business Practice Location Address
First Line	:	4872 CANDLEBERRY AVE
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-3058
Country	:	US
Telephone Number	:	562-225-5633
Fax Number	:	562-596-6901

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	07/08/2007

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