MEDICARE: MINA YOUSSRY YOUSSEF 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	225100000X	Physical Therapist	38694	CA

General Provider Information

NPI Number	:	1518237072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA YOUSSRY YOUSSEF P.T.

Provider Business Mailing Address
First Line	:	1845 BUSINESS CENTER DR
Second Line	:	SUITE 127
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3467
Country	:	US
Telephone Number	:	909-890-9030
Fax Number	:	909-890-4393

Provider Business Practice Location Address
First Line	:	3700 E TACHEVAH DR STE 107
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7402
Country	:	US
Telephone Number	:	760-459-0003
Fax Number	:	760-656-0614

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

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	06/18/2019

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