MEDICARE: MICHAEL JOSEPH BERETTA 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	PT269620	CA

General Provider Information

NPI Number	:	1639161607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JOSEPH BERETTA P.T.

Provider Business Mailing Address
First Line	:	4822 GOLDEN FOOTHILL PKWY UNIT 9
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9829
Country	:	US
Telephone Number	:	916-941-2440
Fax Number	:	916-941-2450

Provider Business Practice Location Address
First Line	:	4822 GOLDEN FOOTHILL PKWY UNIT 9
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9829
Country	:	US
Telephone Number	:	916-941-2440
Fax Number	:	916-941-2450

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	08/01/2025

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