MEDICARE: MA KARLYNNE LOPEZ SABALLA PHYSICAL THERAPY CORPORATION

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

General Provider Information

NPI Number	:	1578754214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MA KARLYNNE LOPEZ SABALLA PHYSICAL THERAPY CORPORATION

Provider Business Mailing Address
First Line	:	18107 SHERMAN WAY
Second Line	:	SUITE 202
City	:	RESEDA
State	:	CA
Zip	:	91335-4582
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18107 SHERMAN WAY
Second Line	:	SUITE 202
City	:	RESEDA
State	:	CA
Zip	:	91335-4582
Country	:	US
Telephone Number	:	818-343-2631
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MA KARLYNNE LOPEZ SABALLA
Credential	:	R.P.T.
Telephone Number	:	818-343-2631

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

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