MEDICARE: AARON MIGUEL P.T.

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	174400000X	Specialist	PT27890	CA

General Provider Information

NPI Number	:	1609062397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON MIGUEL P.T.

Provider Business Mailing Address
First Line	:	PO BOX 37
Second Line	:
City	:	ESPARTO
State	:	CA
Zip	:	95627-0037
Country	:	US
Telephone Number	:	530-662-9161
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 WALNUT ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-3137
Country	:	US
Telephone Number	:	530-662-9161
Fax Number	:

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

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	09/17/2007

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