MEDICARE: MR. EDGAR VINICIO VELA PHYSICAL THERAPIST

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	PT13813	CA

General Provider Information

NPI Number	:	1760608053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDGAR VINICIO VELA PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	2230 N NAOMI ST
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-3226
Country	:	US
Telephone Number	:	818-846-5107
Fax Number	:

Provider Business Practice Location Address
First Line	:	2230 N NAOMI ST
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-3226
Country	:	US
Telephone Number	:	818-846-5107
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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