MEDICARE: SKYLINE 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	225100000X	Physical Therapist	26847	CA

General Provider Information

NPI Number	:	1811332661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYLINE PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	16219 DEVONSHIRE ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6910
Country	:	US
Telephone Number	:	818-831-2400
Fax Number	:	818-831-2411

Provider Business Practice Location Address
First Line	:	16223 DEVONSHIRE ST
Second Line	:
City	:	GRANADA HILLS
State	:	CA
Zip	:	91344-6910
Country	:	US
Telephone Number	:	818-831-2400
Fax Number	:	818-831-2411

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/CEO
Name	:	JON POLLY
Credential	:	PT
Telephone Number	:	818-831-2400

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

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