MEDICARE: DOCTOR'S CHOICE HOME PHYSICAL THERAPY, INC.

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	261QP2000X	Physical Therapy Clinic/Center	PT17911	CA

General Provider Information

NPI Number	:	1780943928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTOR'S CHOICE HOME PHYSICAL THERAPY, INC.

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

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	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JON MARCHESE
Credential	:	PT
Telephone Number	:	949-280-4783

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	05/09/2012

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