MEDICARE: MR. JOHN ANTHONY NATIVO JR. P.T.

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	2251E1200X	Ergonomics Physical Therapist	PT6644	CA

General Provider Information

NPI Number	:	1205103934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ANTHONY NATIVO JR. P.T.

Provider Business Mailing Address
First Line	:	3530 SAN YSIDRO WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95864-2816
Country	:	US
Telephone Number	:	916-396-5350
Fax Number	:	916-488-7522

Provider Business Practice Location Address
First Line	:	3530 SAN YSIDRO WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95864-2816
Country	:	US
Telephone Number	:	916-396-5350
Fax Number	:	916-488-7522

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

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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