MEDICARE: MS. AUDREY CHERNOFSKY 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	172V00000X	Community Health Worker	PT10575	CA

General Provider Information

NPI Number	:	1659553071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AUDREY CHERNOFSKY R.P.T

Provider Business Mailing Address
First Line	:	1515 S BEVERLY DR
Second Line	:	SUITE 102
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-3036
Country	:	US
Telephone Number	:	310-963-8196
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 S BEVERLY DR
Second Line	:	SUITE 102
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-3036
Country	:	US
Telephone Number	:	310-963-8196
Fax Number	:

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

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	11/27/2007

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