MEDICARE: BRIAN A GINGRAS DPT

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 37662	CA

General Provider Information

NPI Number	:	1619268919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN A GINGRAS DPT

Provider Business Mailing Address
First Line	:	3959 RUFFIN RD
Second Line	:	STE J
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1830
Country	:	US
Telephone Number	:	858-279-5570
Fax Number	:	585-279-5303

Provider Business Practice Location Address
First Line	:	3323 CARMEL MOUNTAIN RD
Second Line	:	SUITE 200
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1035
Country	:	US
Telephone Number	:	858-720-0991
Fax Number	:	858-720-0992

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

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	04/29/2016

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