MEDICARE: BRIAN DY PT, DPT, CSCS

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	38412	CA

General Provider Information

NPI Number	:	1598137200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DY PT, DPT, CSCS

Provider Business Mailing Address
First Line	:	10584 MANDEVILLA CT
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-6902
Country	:	US
Telephone Number	:	626-283-1526
Fax Number	:

Provider Business Practice Location Address
First Line	:	10584 MANDEVILLA CT
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-6902
Country	:	US
Telephone Number	:	626-283-1526
Fax Number	:

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

Provider Enumeration Date	:	10/21/2015
Last Update Date	:	10/21/2015

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