MEDICARE: CLAUDIA J LEWETZON MSPT

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	2251G0304X	Geriatric Physical Therapist	PT20081	CA

General Provider Information

NPI Number	:	1417284092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUDIA J LEWETZON MSPT

Provider Business Mailing Address
First Line	:	809 LAUREL ST # 1181
Second Line	:
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-3914
Country	:	US
Telephone Number	:	650-868-3674
Fax Number	:	650-593-7732

Provider Business Practice Location Address
First Line	:	809 LAUREL ST # 1181
Second Line	:
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-3914
Country	:	US
Telephone Number	:	650-868-3674
Fax Number	:	650-593-7732

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

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/16/2009

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