MEDICARE: MRS. JULIE ORSI REYNOLDS-GILLESPIE 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	PT14760	CA
2	2251X0800X	Orthopedic Physical Therapist	I4760	CA

General Provider Information

NPI Number	:	1114044674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE ORSI REYNOLDS-GILLESPIE P.T.

Provider Business Mailing Address
First Line	:	312 S CATALINA AVE STE E
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3622
Country	:	US
Telephone Number	:	424-353-9791
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 S CATALINA AVE STE E
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3622
Country	:	US
Telephone Number	:	424-353-9791
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	06/28/2021

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