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NPI Code Detail

MEDICARE: GREG JOACHIM BS, PTA

MEDICARE: GREG JOACHIM BS, PTA
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
1225200000XPhysical Therapy Assistant9541CA

General Provider Information

NPI Number : 1093096745
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREG JOACHIM BS, PTA
Provider Business Mailing Address
First Line : 615 N NASH ST STE 306
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-2850
Country : US
Telephone Number : 310-535-0008
Fax Number :
Provider Business Practice Location Address
First Line : 615 N NASH ST STE 306
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-2850
Country : US
Telephone Number : 310-535-0008
Fax Number : 310-535-0009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2011
Last Update Date : 09/07/2011

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