MEDICARE: MURIETA PHYSICAL THERAPY

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	PT17746	CA

General Provider Information

NPI Number	:	1477651347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MURIETA PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	7281 LONE PINE DR # 104
Second Line	:	PO BOX 955
City	:	RANCHO MURIETA
State	:	CA
Zip	:	95683-9715
Country	:	US
Telephone Number	:	916-354-0719
Fax Number	:	916-354-1187

Provider Business Practice Location Address
First Line	:	7281 LONE PINE DR
Second Line	:	D104
City	:	RANCHO MURIETA
State	:	CA
Zip	:	95683-9715
Country	:	US
Telephone Number	:	916-354-0719
Fax Number	:	916-354-1187

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KYLE MINORU YAMASHIRO
Credential	:	P.T.
Telephone Number	:	916-354-0719

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	08/22/2020

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Practice Fax:

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