MEDICARE: GLOBAL DOCTOR OF PHYSICAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	2251G0304X	Geriatric Physical Therapist
3	2251N0400X	Neurology Physical Therapist
4	2251X0800X	Orthopedic Physical Therapist
5	2251S0007X	Sports Physical Therapist

General Provider Information

NPI Number	:	1568084762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLOBAL DOCTOR OF PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	13211 CREEK VIEW DR UNIT A
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92844-1277
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	148 MAIN ST STE G
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-6386
Country	:	US
Telephone Number	:	562-493-8426
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FUMIAKI ISSHIKI
Credential	:	DPT
Telephone Number	:	412-961-2138

Provider Enumeration Date	:	05/11/2020
Last Update Date	:	10/05/2020

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