MEDICARE: REBECCA W KERN PT DPT OCS

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	PT6611	CA

General Provider Information

NPI Number	:	1508819285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA W KERN PT DPT OCS

Provider Business Mailing Address
First Line	:	2901 WILSHIRE BLVD
Second Line	:	#440
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4901
Country	:	US
Telephone Number	:	310-315-9711
Fax Number	:	310-315-9349

Provider Business Practice Location Address
First Line	:	2901 WILSHIRE BLVD
Second Line	:	#440
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4901
Country	:	US
Telephone Number	:	310-315-9711
Fax Number	:	310-315-9349

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/08/2007

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