MEDICARE: MR. ALEXANDER SY CONSTANTINO D.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	27555	CA

General Provider Information

NPI Number	:	1659570588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEXANDER SY CONSTANTINO D.P.T.

Provider Business Mailing Address
First Line	:	3545 WILSHIRE BLVD STE 250
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2389
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 WILSHIRE BLVD STE 250
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2389
Country	:	US
Telephone Number	:	818-800-0844
Fax Number	:

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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