MEDICARE: MR. AMIR BURSTEIN M.A,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	171W00000X	Contractor	34312	CA

General Provider Information

NPI Number	:	1336312487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AMIR BURSTEIN M.A,PT

Provider Business Mailing Address
First Line	:	2680 JUNIPER AVE
Second Line	:
City	:	MORRO BAY
State	:	CA
Zip	:	93442-1768
Country	:	US
Telephone Number	:	805-225-1077
Fax Number	:	805-225-1077

Provider Business Practice Location Address
First Line	:	2680 JUNIPER AVE
Second Line	:
City	:	MORRO BAY
State	:	CA
Zip	:	93442-1768
Country	:	US
Telephone Number	:	805-225-1077
Fax Number	:	805-225-1077

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

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/09/2008

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