MEDICARE: JAY ARTHUR FORGERON 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 10849	CA

General Provider Information

NPI Number	:	1053462762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY ARTHUR FORGERON PT

Provider Business Mailing Address
First Line	:	49130 MATZENE DR
Second Line	:
City	:	MORONGO VALLEY
State	:	CA
Zip	:	92256-9705
Country	:	US
Telephone Number	:	760-333-0331
Fax Number	:	760-778-7180

Provider Business Practice Location Address
First Line	:	1090 N PALM CANYON DR STE D
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-4435
Country	:	US
Telephone Number	:	760-778-7150
Fax Number	:	760-778-7180

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	05/13/2019

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