MEDICARE: JERRI LYNN ROBERTSON P.T.

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	36271	CA
2	2251X0800X	Orthopedic Physical Therapist	36271	CA

General Provider Information

NPI Number	:	1336478783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRI LYNN ROBERTSON P.T.

Provider Business Mailing Address
First Line	:	970 MONUMENT STREET
Second Line	:	SUITE 207
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272
Country	:	US
Telephone Number	:	310-573-9553
Fax Number	:	310-573-9533

Provider Business Practice Location Address
First Line	:	1835 S SEPULVEDA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4313
Country	:	US
Telephone Number	:	310-478-6222
Fax Number	:

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

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	03/07/2011

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