MEDICARE: AMY LYNN BABCOCK PT

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	PT 26715	CA

General Provider Information

NPI Number	:	1053394445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LYNN BABCOCK PT

Provider Business Mailing Address
First Line	:	150 PORTOLA RD
Second Line	:
City	:	PORTOLA VALLEY
State	:	CA
Zip	:	94028-7852
Country	:	US
Telephone Number	:	650-851-1145
Fax Number	:	650-851-9251

Provider Business Practice Location Address
First Line	:	150 PORTOLA RD
Second Line	:
City	:	PORTOLA VALLEY
State	:	CA
Zip	:	94028-7852
Country	:	US
Telephone Number	:	650-851-1145
Fax Number	:	650-851-9251

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	03/17/2018

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