MEDICARE: MARA ELIZABETH CORTEZ 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
1	225200000X	Physical Therapy Assistant	11053	CA

General Provider Information

NPI Number	:	1841060787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARA ELIZABETH CORTEZ PTA

Provider Business Mailing Address
First Line	:	3054 BEECHAM ST
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94558-3006
Country	:	US
Telephone Number	:	707-287-2644
Fax Number	:

Provider Business Practice Location Address
First Line	:	3054 BEECHAM ST
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94558-3006
Country	:	US
Telephone Number	:	707-287-2644
Fax Number	:

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

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	01/02/2024

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