MEDICARE: GREG K. KURASHIGE PHYSICAL THERAPIST PC

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	261QP2000X	Physical Therapy Clinic/Center	PT 22641	CA

General Provider Information

NPI Number	:	1639267917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREG K. KURASHIGE PHYSICAL THERAPIST PC

Provider Business Mailing Address
First Line	:	12099 W WASHINGTON BLVD
Second Line	:	SUITE 408
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5882
Country	:	US
Telephone Number	:	310-391-1559
Fax Number	:	310-398-9508

Provider Business Practice Location Address
First Line	:	12099 W WASHINGTON BLVD
Second Line	:	SUITE 408
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5882
Country	:	US
Telephone Number	:	310-391-1559
Fax Number	:	310-398-9508

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GREG KURASHIGE
Credential	:	P.T.
Telephone Number	:	310-391-1559

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/17/2015

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