MEDICARE: ROBIN A BERTHELET PT

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	PT24302	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0207509	OTHER	WA	WA DEPT OF LABOR

General Provider Information

NPI Number	:	1275501843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN A BERTHELET PT

Provider Business Mailing Address
First Line	:	1560 VIA RISA
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-7218
Country	:	US
Telephone Number	:	858-205-8250
Fax Number	:

Provider Business Practice Location Address
First Line	:	1560 VIA RISA
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92078-7218
Country	:	US
Telephone Number	:	858-205-8250
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	06/09/2014

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