MEDICARE: MR. JAMES ROBERT FLOOD MS PT

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	PT13198	CA

General Provider Information

NPI Number	:	1710098421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ROBERT FLOOD MS PT

Provider Business Mailing Address
First Line	:	11178 INDIAN LORE CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92127
Country	:	US
Telephone Number	:	858-451-5610
Fax Number	:	858-485-7052

Provider Business Practice Location Address
First Line	:	11501 RANCHO BERNARDO
Second Line	:	STE #100
City	:	SAN DIEGO
State	:	CA
Zip	:	92127-1404
Country	:	US
Telephone Number	:	858-485-6706
Fax Number	:	858-485-7052

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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