MEDICARE: PRIOR LEVEL HOME CARE 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	251E00000X	Home Health Agency		CA

General Provider Information

NPI Number	:	1912493750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIOR LEVEL HOME CARE PHYSICAL THERAPY INC.

Provider Business Mailing Address
First Line	:	1200 CALIFORNIA ST STE 112
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-2946
Country	:	US
Telephone Number	:	909-312-7099
Fax Number	:	909-312-7809

Provider Business Practice Location Address
First Line	:	1200 CALIFORNIA ST STE 112
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-2946
Country	:	US
Telephone Number	:	909-312-7099
Fax Number	:	909-312-7809

Authorized Official
Title or Position	:	CEO/OWNER/ADMINISTRATOR
Name	:	MRS. ALISON RAE MCCLINTOCK
Credential	:	PT
Telephone Number	:	805-215-2547

Provider Enumeration Date	:	07/05/2018
Last Update Date	:	07/05/2018

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