MEDICARE: MR. DONALD JOHN DENDINGER MPT

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	PT212770	CA

General Provider Information

NPI Number	:	1841402039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD JOHN DENDINGER MPT

Provider Business Mailing Address
First Line	:	1874 TICE VALLEY BLVD
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94595-2224
Country	:	US
Telephone Number	:	925-935-0510
Fax Number	:	925-935-0750

Provider Business Practice Location Address
First Line	:	1874 TICE VALLEY BLVD
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94595-2224
Country	:	US
Telephone Number	:	925-935-0510
Fax Number	:	925-935-0750

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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