MEDICARE: MARITA ABAD 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

General Provider Information

NPI Number	:	1407361017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITA ABAD PTA

Provider Business Mailing Address
First Line	:	3827 1/2 BRESEE AVE
Second Line	:
City	:	BALDWIN PARK
State	:	CA
Zip	:	91706-4176
Country	:	US
Telephone Number	:	626-250-4512
Fax Number	:

Provider Business Practice Location Address
First Line	:	3233 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3640
Country	:	US
Telephone Number	:	323-734-9122
Fax Number	:

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

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	12/05/2017

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Directions to “ MARITA ABAD PTA” Practice Location

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