MEDICARE: CARMEN CATHERINE TATLOW PT DPT

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	PT32991	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT32991	OTHER	CA	PT STATE LICENSE

General Provider Information

NPI Number	:	1780795971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMEN CATHERINE TATLOW PT DPT

Provider Business Mailing Address
First Line	:	5 CARLSBAD LN
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-6070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24582 DEL PRADO
Second Line	:	STE C
City	:	DANA POINT
State	:	CA
Zip	:	92629-3843
Country	:	US
Telephone Number	:	949-443-0713
Fax Number	:	949-443-0721

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/09/2013

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