MEDICARE: MR. STEVE CREAR

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	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	6014	NY
2	2251S0007X	Sports Physical Therapist	6014	NY
3	2251X0800X	Orthopedic Physical Therapist	6014	NY

General Provider Information

NPI Number	:	1528389897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVE CREAR

Provider Business Mailing Address
First Line	:	12424 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1052
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12424 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1052
Country	:	US
Telephone Number	:	310-826-2977
Fax Number	:	310-826-5687

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

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/21/2010

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