MEDICARE: MARY LYDIA ENGLES

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	174400000X	Specialist	PT6252	CA

General Provider Information

NPI Number	:	1104917095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY LYDIA ENGLES

Provider Business Mailing Address
First Line	:	4120 WEST POINT LOMA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5605
Country	:	US
Telephone Number	:	619-226-4131
Fax Number	:	619-226-4124

Provider Business Practice Location Address
First Line	:	4120 WEST POINT LOMA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5605
Country	:	US
Telephone Number	:	619-226-4131
Fax Number	:	619-226-4124

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MS. MARY LYDIA ENGLES
Credential	:	PT
Telephone Number	:	619-226-4131

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	05/07/2012

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