MEDICARE: MICHELLE SUDARIA DAUS DPT

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	39925	CA

General Provider Information

NPI Number	:	1679813539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SUDARIA DAUS DPT

Provider Business Mailing Address
First Line	:	6695 E PACIFIC COAST HWY
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4235
Country	:	US
Telephone Number	:	562-596-7074
Fax Number	:	562-596-7214

Provider Business Practice Location Address
First Line	:	6695 E PACIFIC COAST HWY
Second Line	:	SUITE 100
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4235
Country	:	US
Telephone Number	:	562-596-7074
Fax Number	:	562-596-7214

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

Provider Enumeration Date	:	02/28/2013
Last Update Date	:	02/28/2013

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