MEDICARE: KRISTINA MONNESS ORLICZKY 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	225100000X	Physical Therapist	18833	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18833	OTHER	CA	PHYSICAL THERAPY

General Provider Information

NPI Number	:	1629016779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA MONNESS ORLICZKY P.T.

Provider Business Mailing Address
First Line	:	1025 COASTLINE DR
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-5814
Country	:	US
Telephone Number	:	562-715-2852
Fax Number	:	562-431-3344

Provider Business Practice Location Address
First Line	:	1025 COASTLINE DR
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-5814
Country	:	US
Telephone Number	:	562-715-2852
Fax Number	:	562-431-3344

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	09/28/2007

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