MEDICARE: PETER LA JOY

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	10543	AZ

General Provider Information

NPI Number	:	1710307335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER LA JOY

Provider Business Mailing Address
First Line	:	1400 N SAN ANTONIO AVE
Second Line	:
City	:	DOUGLAS
State	:	AZ
Zip	:	85607-2434
Country	:	US
Telephone Number	:	888-873-4221
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 N SAN ANTONIO AVE
Second Line	:
City	:	DOUGLAS
State	:	AZ
Zip	:	85607-2434
Country	:	US
Telephone Number	:	888-873-4221
Fax Number	:

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

Provider Enumeration Date	:	04/22/2014
Last Update Date	:	04/22/2014

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Directions to “ PETER LA JOY ” Practice Location

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