MEDICARE: MR. PETER MILINAZZO III MSOT

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	225XP0019X	Physical Rehabilitation Occupational Therapist	14333	CA

General Provider Information

NPI Number	:	1639951445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER MILINAZZO III MSOT

Provider Business Mailing Address
First Line	:	375 BUOY WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-2404
Country	:	US
Telephone Number	:	415-203-7301
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 FLORIN RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-2024
Country	:	US
Telephone Number	:	916-393-2550
Fax Number	:

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

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	10/17/2023

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