MEDICARE: BRET EDWARD MCLEOD 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	PT26835	CA

General Provider Information

NPI Number	:	1770557167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRET EDWARD MCLEOD PT

Provider Business Mailing Address
First Line	:	817 OMAR ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202
Country	:	US
Telephone Number	:	818-653-5886
Fax Number	:

Provider Business Practice Location Address
First Line	:	3808 W RIVERSIDE DR STE 300
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4339
Country	:	US
Telephone Number	:	818-237-5759
Fax Number	:

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	04/13/2018

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