MEDICARE: MRS. SUMMER CHONG RHEE-PIZANO PT, LAC

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	PT20648	CA
2	171100000X	Acupuncturist	AC9296	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0PT206481	OTHER	CA	BLUE SHIELD
2	CA0092960	OTHER		BLUE SHIELD
3	OPT206480	OTHER	CA	BLUE SHIELD PROVIDER NUMB
4	CA0092961	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1740285808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUMMER CHONG RHEE-PIZANO PT, LAC

Provider Business Mailing Address
First Line	:	1500 PARK AVE
Second Line	:	UNIT 2
City	:	CAPITOLA
State	:	CA
Zip	:	95010-2448
Country	:	US
Telephone Number	:	831-239-9978
Fax Number	:

Provider Business Practice Location Address
First Line	:	2825 PORTER ST STE B
Second Line	:
City	:	SOQUEL
State	:	CA
Zip	:	95073-2467
Country	:	US
Telephone Number	:	831-239-9978
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	12/18/2017

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