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NPI Code Detail

MEDICARE: MARYROSE PHARO PTA

MEDICARE: MARYROSE PHARO PTA
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
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1821561309
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYROSE PHARO PTA
Provider Business Mailing Address
First Line : 2790 HAVASUPAI AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92117-1634
Country : US
Telephone Number : 619-316-4959
Fax Number :
Provider Business Practice Location Address
First Line : 4435 EASTGATE MALL STE 120
Second Line :
City : SAN DIEGO
State : CA
Zip : 92121-1980
Country : US
Telephone Number : 858-578-8669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2019
Last Update Date : 01/07/2019

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Directions to “ MARYROSE PHARO PTA” Practice Location

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