MEDICARE: MS. CAROL REMZ HOESLY P.T.

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	2251P0200X	Pediatric Physical Therapist	PT8635	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CMS037225	OTHER	CA	MEDI-CAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1508088436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL REMZ HOESLY P.T.

Provider Business Mailing Address
First Line	:	812 HARKNESS ST.
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6330
Country	:	US
Telephone Number	:	310-374-2324
Fax Number	:	310-374-5035

Provider Business Practice Location Address
First Line	:	812 HARKNESS ST.
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6330
Country	:	US
Telephone Number	:	310-374-2324
Fax Number	:	310-374-5035

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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