MEDICARE: MC PHYSICAL THERAPY

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

General Provider Information

NPI Number	:	1134175169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MC PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	2082 POINTE PKWY
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-2018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2082 POINTE PKWY
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91978-2018
Country	:	US
Telephone Number	:	619-838-6158
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MICHELE KATHERINE CAZALAS
Credential	:	PT
Telephone Number	:	619-838-6158

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	08/22/2020

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Directions to “MC PHYSICAL THERAPY ” Practice Location

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