MEDICARE: MS. MARIBETH ANN CONDON 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	225100000X	Physical Therapist	13827	CA

General Provider Information

NPI Number	:	1437270238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIBETH ANN CONDON PT

Provider Business Mailing Address
First Line	:	4747 MISSION BLVD STE 4A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2541
Country	:	US
Telephone Number	:	619-226-4810
Fax Number	:

Provider Business Practice Location Address
First Line	:	4747 MISSION BLVD STE 4A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2541
Country	:	US
Telephone Number	:	858-581-6900
Fax Number	:	858-581-6999

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	05/16/2013

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