MEDICARE: MR. STEVE ARNOLD THRALL 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	PT9913	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ070872	OTHER	CA	BLUE SHIELD
2	0008158486	OTHER	CA	AETNA

General Provider Information

NPI Number	:	1295734788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVE ARNOLD THRALL PT

Provider Business Mailing Address
First Line	:	6560 GREENBACK LANE
Second Line	:	STE 100
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-6227
Country	:	US
Telephone Number	:	916-723-3372
Fax Number	:	916-723-1638

Provider Business Practice Location Address
First Line	:	6560 GREENBACK LANE
Second Line	:	STE 100
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-6227
Country	:	US
Telephone Number	:	916-723-3372
Fax Number	:	916-723-1638

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	02/27/2008

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