MEDICARE: GAIL NILES 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	PT5239	CA

General Provider Information

NPI Number	:	1790995801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL NILES P.T.

Provider Business Mailing Address
First Line	:	3940 LAUREL CANYON BLVD
Second Line	:	UNIT 254
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3709
Country	:	US
Telephone Number	:	818-395-3953
Fax Number	:

Provider Business Practice Location Address
First Line	:	3959 LAUREL CANYON BLVD
Second Line	:	SUITE L
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-4921
Country	:	US
Telephone Number	:	818-395-3953
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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