MEDICARE: SONSHINE REHAB & PHYSICAL THERAPY CENTER, A PROFESSIONAL CORPORATION

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		CA

General Provider Information

NPI Number	:	1669630166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONSHINE REHAB & PHYSICAL THERAPY CENTER, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	2140 W OLYMPIC BLVD
Second Line	:	SUITE 301
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2207
Country	:	US
Telephone Number	:	213-383-0191
Fax Number	:	213-383-0190

Provider Business Practice Location Address
First Line	:	2140 W OLYMPIC BLVD
Second Line	:	SUITE 301
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2207
Country	:	US
Telephone Number	:	213-383-0191
Fax Number	:	213-383-0190

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT T NAKAMOTO
Credential	:	PT
Telephone Number	:	213-383-0191

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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