MEDICARE: KATHERINE ELISE MAGOLSKE PTA

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	225200000X	Physical Therapy Assistant	AT 5588	CA

General Provider Information

NPI Number	:	1316163421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ELISE MAGOLSKE PTA

Provider Business Mailing Address
First Line	:	143 N COMMONWEALTH AVE
Second Line	:	APT. 2
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3634
Country	:	US
Telephone Number	:	213-252-1785
Fax Number	:

Provider Business Practice Location Address
First Line	:	143 N COMMONWEALTH AVE
Second Line	:	APT. 2
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3634
Country	:	US
Telephone Number	:	213-252-1785
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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