MEDICARE: JOSELITO RIZALDO BABARAN IRINGAN LPT

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	37212	CA
2	225100000X	Physical Therapist	114450	MO

General Provider Information

NPI Number	:	1417251349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSELITO RIZALDO BABARAN IRINGAN LPT

Provider Business Mailing Address
First Line	:	9723 COLLIE WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-6223
Country	:	US
Telephone Number	:	573-718-0014
Fax Number	:

Provider Business Practice Location Address
First Line	:	9723 COLLIE WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-6223
Country	:	US
Telephone Number	:	573-718-0014
Fax Number	:

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

Provider Enumeration Date	:	01/06/2011
Last Update Date	:	01/06/2011

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Directions to “ JOSELITO RIZALDO BABARAN IRINGAN LPT” Practice Location

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