MEDICARE: MR. JOE DEJESUS PADILLA 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
1	225200000X	Physical Therapy Assistant	3922	CA

General Provider Information

NPI Number	:	1396904827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOE DEJESUS PADILLA PTA

Provider Business Mailing Address
First Line	:	1873 KNOXVILLE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-3438
Country	:	US
Telephone Number	:	714-633-3568
Fax Number	:	714-633-1607

Provider Business Practice Location Address
First Line	:	1873 KNOXVILLE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-3438
Country	:	US
Telephone Number	:	714-633-3568
Fax Number	:	714-633-1608

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

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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