MEDICARE: CHARLES HOMOKY PT, DPT

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	293063	CA

General Provider Information

NPI Number	:	1285163535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES HOMOKY PT, DPT

Provider Business Mailing Address
First Line	:	3560 EMERALD ST APT C
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90503-3756
Country	:	US
Telephone Number	:	561-306-3372
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 PARK TER STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-1546
Country	:	US
Telephone Number	:	310-665-7100
Fax Number	:

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

Provider Enumeration Date	:	06/09/2017
Last Update Date	:	06/09/2017

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Directions to “ CHARLES HOMOKY PT, DPT” Practice Location

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