MEDICARE: BOJIL PETROV SHTEREV 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	6516	CA

General Provider Information

NPI Number	:	1487858254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOJIL PETROV SHTEREV PTA

Provider Business Mailing Address
First Line	:	6100 EDINGER AVE APT 129
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3288
Country	:	US
Telephone Number	:	714-377-5624
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 EDINGER AVE APT 129
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3288
Country	:	US
Telephone Number	:	714-377-5624
Fax Number	:

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	07/08/2007

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