MEDICARE: MS. ANNE BRIDGET HOWARD MPT

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	PT18981	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPT 189810	OTHER	CA	BLUE SHIELD ID #

General Provider Information

NPI Number	:	1194708040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE BRIDGET HOWARD MPT

Provider Business Mailing Address
First Line	:	PO BOX 2772
Second Line	:
City	:	APTOS
State	:	CA
Zip	:	95001-2772
Country	:	US
Telephone Number	:	831-247-5584
Fax Number	:	831-336-4255

Provider Business Practice Location Address
First Line	:	3121 PARK AVE
Second Line	:	SUITE K
City	:	SOQUEL
State	:	CA
Zip	:	95073-2920
Country	:	US
Telephone Number	:	831-247-5584
Fax Number	:	831-464-8809

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	05/06/2010

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