MEDICARE: MR. JAMES JOSEPH DAGOSTINO DPT PT

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	PT6791	CA

General Provider Information

NPI Number	:	1154397107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES JOSEPH DAGOSTINO DPT PT

Provider Business Mailing Address
First Line	:	3809 PLAZA DR
Second Line	:	STE 112
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4625
Country	:	US
Telephone Number	:	760-941-2630
Fax Number	:	760-941-4617

Provider Business Practice Location Address
First Line	:	3809 PLAZA DR
Second Line	:	STE 112
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4625
Country	:	US
Telephone Number	:	760-941-2630
Fax Number	:	760-941-4617

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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