MEDICARE: MR. JON PAUL MARCHESE P.T.

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	PT 17911	CA

General Provider Information

NPI Number	:	1780769190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JON PAUL MARCHESE P.T.

Provider Business Mailing Address
First Line	:	39 CALLE LOYOLA
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-7018
Country	:	US
Telephone Number	:	949-280-4783
Fax Number	:	949-429-2319

Provider Business Practice Location Address
First Line	:	39 CALLE LOYOLA
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-7018
Country	:	US
Telephone Number	:	949-280-4783
Fax Number	:	949-429-2319

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/09/2012

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