MEDICARE: MRS. MARISSA RUTH MEUCCI M.S.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	PT28884	CA

General Provider Information

NPI Number	:	1346485497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARISSA RUTH MEUCCI M.S.P.T.

Provider Business Mailing Address
First Line	:	1187 COAST VILLAGE RD STE 8
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2762
Country	:	US
Telephone Number	:	805-565-5670
Fax Number	:	805-565-5690

Provider Business Practice Location Address
First Line	:	1187 COAST VILLAGE RD STE 8
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93108-2762
Country	:	US
Telephone Number	:	805-565-5670
Fax Number	:	805-565-5690

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

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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