MEDICARE: PHYSICAL THERAPY INNOVATIONS, INC.

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

General Provider Information

NPI Number	:	1710021993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY INNOVATIONS, INC.

Provider Business Mailing Address
First Line	:	425 KEARNEY ST
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-3656
Country	:	US
Telephone Number	:	510-524-2177
Fax Number	:	510-525-2875

Provider Business Practice Location Address
First Line	:	1922 WEBSTER ST
Second Line	:	SUITE B
City	:	OAKLAND
State	:	CA
Zip	:	94612-2910
Country	:	US
Telephone Number	:	510-271-4793
Fax Number	:	510-525-2875

Authorized Official
Title or Position	:	PT/PRESIDENT
Name	:	MR. ALLEN L LING
Credential	:	M.P.T.
Telephone Number	:	510-524-2177

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	08/23/2013

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