MEDICARE: MR. JOSEPH L SERRANO RPT

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	PT17259	CA

General Provider Information

NPI Number	:	1982741500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH L SERRANO RPT

Provider Business Mailing Address
First Line	:	4157 EAGLE ROCK BLVD
Second Line	:	SUITE 7
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-4492
Country	:	US
Telephone Number	:	323-982-1566
Fax Number	:	323-982-1680

Provider Business Practice Location Address
First Line	:	4157 EAGLE ROCK BLVD
Second Line	:	SUITE 7
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-4492
Country	:	US
Telephone Number	:	323-982-1566
Fax Number	:	323-982-1680

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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