MEDICARE: CHARLES RICHARD FELDER PT, DPT, MBA

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	PT8851	CA

General Provider Information

NPI Number	:	1275627879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES RICHARD FELDER PT, DPT, MBA

Provider Business Mailing Address
First Line	:	2275 S MAIN ST STE 105
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-5303
Country	:	US
Telephone Number	:	951-273-7748
Fax Number	:	951-273-7627

Provider Business Practice Location Address
First Line	:	2275 S MAIN ST STE 105
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-5303
Country	:	US
Telephone Number	:	951-273-7748
Fax Number	:	951-273-7627

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/27/2012

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