MEDICARE: MEDSTAR PHYSICAL THERAPY, INC.

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	PT12100	CA

General Provider Information

NPI Number	:	1871854315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSTAR PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	3427 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3254
Country	:	US
Telephone Number	:	818-244-0009
Fax Number	:	818-244-1703

Provider Business Practice Location Address
First Line	:	3427 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3254
Country	:	US
Telephone Number	:	818-244-0009
Fax Number	:	818-244-1703

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAJID SAEDIFAR
Credential	:	RPT
Telephone Number	:	818-244-0009

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	05/31/2012

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