MEDICARE: CONSTANCE MEHLMAN 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	225100000X	Physical Therapist	15490	CA

General Provider Information

NPI Number	:	1255628137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE MEHLMAN P.T.

Provider Business Mailing Address
First Line	:	5018 OLD CLIFFS RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-1150
Country	:	US
Telephone Number	:	619-487-1563
Fax Number	:

Provider Business Practice Location Address
First Line	:	5018 OLD CLIFFS RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-1150
Country	:	US
Telephone Number	:	619-487-1563
Fax Number	:

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

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	06/29/2011

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