MEDICARE: SAN CLEMENTE PHYSICAL THERAPY INC

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	PT 7668	CA
2	225200000X	Physical Therapy Assistant	AT 2864	CA
3	225100000X	Physical Therapist	PT 9681	CA

General Provider Information

NPI Number	:	1134237985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN CLEMENTE PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	647 CAMINO DE LOS MARES
Second Line	:	SUITE 111
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-2806
Country	:	US
Telephone Number	:	949-240-0600
Fax Number	:	949-240-7578

Provider Business Practice Location Address
First Line	:	647 CAMINO DE LOS MARES
Second Line	:	SUITE 111
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-2806
Country	:	US
Telephone Number	:	949-240-0600
Fax Number	:	949-240-7578

Authorized Official
Title or Position	:	CO OWNER PT
Name	:	MR. DAVID W REENDERS
Credential	:	PT
Telephone Number	:	949-240-0600

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	09/29/2008

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