MEDICARE: MR. PETER CHIRICO PT

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	PT8303	CA

General Provider Information

NPI Number	:	1619989027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER CHIRICO PT

Provider Business Mailing Address
First Line	:	2601 W ALAMEDA AVE
Second Line	:	SUITE #308
City	:	BURBANK
State	:	CA
Zip	:	91505-4814
Country	:	US
Telephone Number	:	818-972-2811
Fax Number	:	818-972-2918

Provider Business Practice Location Address
First Line	:	2601 W ALAMEDA AVE
Second Line	:	SUITE #308
City	:	BURBANK
State	:	CA
Zip	:	91505-4814
Country	:	US
Telephone Number	:	818-972-2811
Fax Number	:	818-972-2918

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	01/13/2009

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