MEDICARE: MR. GAREY RAYMOND 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	PT22017	CA

General Provider Information

NPI Number	:	1649241456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GAREY RAYMOND P.T

Provider Business Mailing Address
First Line	:	531 LARCHMONT BLVD
Second Line	:	STE# 2
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3013
Country	:	US
Telephone Number	:	323-465-9180
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 N LARCHMONT BLVD
Second Line	:	STE# 2
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3013
Country	:	US
Telephone Number	:	323-465-9180
Fax Number	:

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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