MEDICARE: CHRISTOPHER P. DOVRE 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	26270	CA

General Provider Information

NPI Number	:	1588853188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER P. DOVRE P.T.

Provider Business Mailing Address
First Line	:	33841 ARRASTRA DR
Second Line	:
City	:	YUCAIPA
State	:	CA
Zip	:	92399-6961
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	42080 STATE ST
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-5173
Country	:	US
Telephone Number	:	760-568-2894
Fax Number	:

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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