MEDICARE: NOEMILYN BURLAZA TSUKUSHI PHYSICAL THERAPIST

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	172V00000X	Community Health Worker	PT1701	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT1701	OTHER	CA	APTA

General Provider Information

NPI Number	:	1245761998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEMILYN BURLAZA TSUKUSHI PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	3658 FARM HILL BLVD
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-1231
Country	:	US
Telephone Number	:	650-346-4693
Fax Number	:

Provider Business Practice Location Address
First Line	:	3658 FARM HILL BLVD
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-1231
Country	:	US
Telephone Number	:	650-346-4693
Fax Number	:

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

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	03/24/2017

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