MEDICARE: MRS. NUBITI KAMI-CADLE RPT

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	PT11694	CA

General Provider Information

NPI Number	:	1710264155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NUBITI KAMI-CADLE RPT

Provider Business Mailing Address
First Line	:	13405 CUMBERLAND PL
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-5448
Country	:	US
Telephone Number	:	909-641-3201
Fax Number	:	909-463-3699

Provider Business Practice Location Address
First Line	:	19239 COLIMA RD
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-3005
Country	:	US
Telephone Number	:	626-581-7898
Fax Number	:	626-581-3018

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

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	01/17/2012

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