MEDICARE: MS. VALERY MATSUMOTO P.T.

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	PT11850	CA

General Provider Information

NPI Number	:	1053498246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VALERY MATSUMOTO P.T.

Provider Business Mailing Address
First Line	:	4357 SEPULVEDA BLVD UNIT A
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4715
Country	:	US
Telephone Number	:	310-391-1559
Fax Number	:	310-398-9481

Provider Business Practice Location Address
First Line	:	4357 SEPULVEDA BLVD UNIT A
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4715
Country	:	US
Telephone Number	:	310-391-1559
Fax Number	:	310-398-9481

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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