MEDICARE: MR. RICHARD THOMAS STUELPNAGEL 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	PT 19588	CA

General Provider Information

NPI Number	:	1235244948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD THOMAS STUELPNAGEL PT

Provider Business Mailing Address
First Line	:	318 WINSLOW AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814
Country	:	US
Telephone Number	:	562-596-7074
Fax Number	:	562-596-7214

Provider Business Practice Location Address
First Line	:	6382 C EAST PACIFIC COAST HWY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4804
Country	:	US
Telephone Number	:	562-596-7074
Fax Number	:	562-596-7214

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	11/05/2010

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