MEDICARE: PARK MEDICAL PHYSICAL THERAPY, PROF CORP

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	332BC3200X	Customized Equipment (DME)	PT7388	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies	PT7388	CA
3	335E00000X	Prosthetic/Orthotic Supplier	PT7388	CA

General Provider Information

NPI Number	:	1295904308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK MEDICAL PHYSICAL THERAPY, PROF CORP

Provider Business Mailing Address
First Line	:	4136 BACHMAN PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2028
Country	:	US
Telephone Number	:	619-297-2544
Fax Number	:	619-297-2752

Provider Business Practice Location Address
First Line	:	4120 W POINT LOMA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5605
Country	:	US
Telephone Number	:	619-297-2544
Fax Number	:	619-297-2752

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	LINDA JOYCE CHRISTENSEN
Credential	:	PT
Telephone Number	:	619-297-2544

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/27/2008

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Directions to “PARK MEDICAL PHYSICAL THERAPY, PROF CORP ” Practice Location

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