MEDICARE: AMASHA 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		CA

General Provider Information

NPI Number	:	1639228240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMASHA PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	PO BOX 3170
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92628-3170
Country	:	US
Telephone Number	:	310-404-1571
Fax Number	:	213-402-2670

Provider Business Practice Location Address
First Line	:	266 S HARVARD BLVD
Second Line	:	SUITE 206
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4372
Country	:	US
Telephone Number	:	310-404-1571
Fax Number	:	213-402-2670

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAMMY O AMASHA
Credential	:	RPT
Telephone Number	:	213-739-2226

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	09/30/2010

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