MEDICARE: MICHAEL KWAN THACH 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	2251X0800X	Orthopedic Physical Therapist	37980	CA

General Provider Information

NPI Number	:	1780963215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL KWAN THACH P.T.

Provider Business Mailing Address
First Line	:	22151 CLARENDON ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6308
Country	:	US
Telephone Number	:	818-884-4810
Fax Number	:

Provider Business Practice Location Address
First Line	:	22151 CLARENDON ST
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6308
Country	:	US
Telephone Number	:	818-884-4810
Fax Number	:

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

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	10/23/2019

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