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NPI Code Detail

MEDICARE: MR. CHARLES DAVID JR. PTA

MEDICARE: MR. CHARLES DAVID JR. PTA
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
1225200000XPhysical Therapy Assistant10582CA

General Provider Information

NPI Number : 1366847212
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES DAVID JR. PTA
Provider Business Mailing Address
First Line : 16701 LYNN LN APT B
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92649-3463
Country : US
Telephone Number : 678-231-6011
Fax Number :
Provider Business Practice Location Address
First Line : 5810 DOWNEY AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90805-4517
Country : US
Telephone Number : 562-380-2178
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2014
Last Update Date : 04/06/2023

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