MEDICARE: SOUTH COAST P.T.INC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1265632830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COAST P.T.INC

Provider Business Mailing Address
First Line	:	23024 LAKE FOREST DR
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1328
Country	:	US
Telephone Number	:	949-855-3926
Fax Number	:	949-855-3921

Provider Business Practice Location Address
First Line	:	23024 LAKE FOREST DR
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1328
Country	:	US
Telephone Number	:	949-855-3926
Fax Number	:	949-855-3921

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SETAREH SALEHI
Credential	:	PT
Telephone Number	:	949-855-3926

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	07/23/2007

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