MEDICARE: PATRICIA ANN LA BOUFF 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	PT 7949	CA

General Provider Information

NPI Number	:	1477755783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ANN LA BOUFF PT

Provider Business Mailing Address
First Line	:	8584 FANITA DR
Second Line	:
City	:	SANTEE
State	:	CA
Zip	:	92071-4019
Country	:	US
Telephone Number	:	619-807-5510
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 MOUNT EVEREST BLVD
Second Line	:	WIGGIN CENTER, B-11
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-4847
Country	:	US
Telephone Number	:	858-573-5972
Fax Number	:	858-573-5985

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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