MEDICARE: GEORGE NICK LENDARIS R.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	PT9097	CA

General Provider Information

NPI Number	:	1639266133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE NICK LENDARIS R.P.T.

Provider Business Mailing Address
First Line	:	3030 BEARD RD
Second Line	:	SUITE B
City	:	NAPA
State	:	CA
Zip	:	94558-3490
Country	:	US
Telephone Number	:	707-257-0686
Fax Number	:	707-257-7670

Provider Business Practice Location Address
First Line	:	3030 BEARD RD
Second Line	:	SUITE B
City	:	NAPA
State	:	CA
Zip	:	94558-3490
Country	:	US
Telephone Number	:	707-257-0686
Fax Number	:	707-257-7670

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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