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NPI Code Detail

MEDICARE: KELLI M BARUCH DPT

MEDICARE: KELLI M BARUCH 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
1225100000XPhysical Therapist39615CA
22251X0800XOrthopedic Physical TherapistPT39615CA

General Provider Information

NPI Number : 1346587631
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI M BARUCH DPT
Provider Business Mailing Address
First Line : 12465 LEWIS STREET
Second Line : SUITE 101
City : GARDEN GROVE
State : CA
Zip : 92840-4658
Country : US
Telephone Number : 714-703-8477
Fax Number : 714-703-8157
Provider Business Practice Location Address
First Line : 12465 LEWIS STREET
Second Line : SUITE 101
City : GARDEN GROVE
State : CA
Zip : 92840-4658
Country : US
Telephone Number : 714-703-8477
Fax Number : 714-703-8157
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2013
Last Update Date : 08/15/2018

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Directions to “ KELLI M BARUCH DPT” Practice Location

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