MEDICARE: JULIAN P. YNIGUEZ 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	PT26361	CA

General Provider Information

NPI Number	:	1811051105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIAN P. YNIGUEZ PHYSICAL THERAPY, INC

Provider Business Mailing Address
First Line	:	591 S AZUSA WAY
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-5113
Country	:	US
Telephone Number	:	626-964-5123
Fax Number	:	626-964-5105

Provider Business Practice Location Address
First Line	:	591 S AZUSA WAY
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-5113
Country	:	US
Telephone Number	:	626-964-5123
Fax Number	:	626-964-5105

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JULIAN YNIGUEZ
Credential	:	P.T.
Telephone Number	:	626-964-5123

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	08/22/2020

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