MEDICARE: MARYVEE ASINO TAN 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	PT 20930	CA

General Provider Information

NPI Number	:	1326216383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYVEE ASINO TAN PT

Provider Business Mailing Address
First Line	:	1041 HARBOR HEIGHTS DR UNIT I
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-3086
Country	:	US
Telephone Number	:	310-326-5093
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 HARBOR HEIGHTS DR UNIT I
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-3086
Country	:	US
Telephone Number	:	310-326-5093
Fax Number	:

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

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/13/2008

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