MEDICARE: MRS. KATHERINE GRACE CREAMER 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	PT-34827	CA

General Provider Information

NPI Number	:	1316193089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE GRACE CREAMER P.T.

Provider Business Mailing Address
First Line	:	6695 EAST PACIFIC COAST HWY
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6695 EAST PACIFIC COAST HWY
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4804
Country	:	US
Telephone Number	:	562-596-7074
Fax Number	:	562-596-7214

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

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	10/16/2012

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