MEDICARE: MEDSTAR PHYSICAL THERAPY INC.

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

General Provider Information

NPI Number	:	1598919268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSTAR PHYSICAL THERAPY INC.

Provider Business Mailing Address
First Line	:	275 W SAN BERNARDINO RD
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-1516
Country	:	US
Telephone Number	:	626-967-3553
Fax Number	:	626-915-7403

Provider Business Practice Location Address
First Line	:	275 W SAN BERNARDINO RD
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-1516
Country	:	US
Telephone Number	:	626-967-3553
Fax Number	:	626-915-7403

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ROBERT ALFONSO HERRERA
Credential	:	ETC
Telephone Number	:	626-641-5125

Provider Enumeration Date	:	11/07/2008
Last Update Date	:	05/25/2012

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