MEDICARE: MONTECITO ALLIED HEALTH, LLC

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1184868358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTECITO ALLIED HEALTH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 20433
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77225-0433
Country	:	US
Telephone Number	:	713-277-8771
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 S BRAESWOOD BLVD # 31A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4321
Country	:	US
Telephone Number	:	713-277-8771
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUDY ANICETO
Credential	:	PT
Telephone Number	:	713-277-8771

Provider Enumeration Date	:	05/01/2009
Last Update Date	:	05/01/2009

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