MEDICARE: TIMOTHY LEE KLEIN-MOHR 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	225100000X	Physical Therapist	AT6197	CA

General Provider Information

NPI Number	:	1437197548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY LEE KLEIN-MOHR PTA

Provider Business Mailing Address
First Line	:	7 FLOWERIDGE CIR
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-4903
Country	:	US
Telephone Number	:	949-481-9869
Fax Number	:

Provider Business Practice Location Address
First Line	:	26522 LA ALAMEDA
Second Line	:	SUITE 100
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6330
Country	:	US
Telephone Number	:	949-582-2555
Fax Number	:

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	11/05/2013

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