MEDICARE: CARLA ANNETTE PEAY M.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	225100000X	Physical Therapist	PT18811	CA

General Provider Information

NPI Number	:	1831412832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA ANNETTE PEAY M.P.T.

Provider Business Mailing Address
First Line	:	5300 FAIRVIEW BLVD
Second Line	:	#26
City	:	LOS ANGELES
State	:	CA
Zip	:	90056-2357
Country	:	US
Telephone Number	:	310-403-1038
Fax Number	:

Provider Business Practice Location Address
First Line	:	7188 W SUNSET BLVD
Second Line	:	SUITE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-4400
Country	:	US
Telephone Number	:	323-436-0006
Fax Number	:

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

Provider Enumeration Date	:	03/04/2010
Last Update Date	:	03/04/2010

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