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NPI Code Detail

MEDICARE: MR. GINO JOHN BRUNELLO P.T.

MEDICARE: MR. GINO JOHN BRUNELLO 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
1225100000XPhysical TherapistPT16371CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2OPT163710OTHERCABLUE SHIELD

General Provider Information

NPI Number : 1063579910
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GINO JOHN BRUNELLO P.T.
Provider Business Mailing Address
First Line : 2530 PROFESSIONAL PKWY
Second Line :
City : SANTA MARIA
State : CA
Zip : 93455-1602
Country : US
Telephone Number : 805-928-4465
Fax Number : 805-928-7935
Provider Business Practice Location Address
First Line : 2530 PROFESSIONAL PKWY
Second Line :
City : SANTA MARIA
State : CA
Zip : 93455-1602
Country : US
Telephone Number : 805-928-4465
Fax Number : 805-928-7935
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 07/08/2007

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