MEDICARE: SUSAN MAE MCGINTY PT, EDD

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	PT 2186	CA

General Provider Information

NPI Number	:	1902974587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MAE MCGINTY PT, EDD

Provider Business Mailing Address
First Line	:	1124 45TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3719
Country	:	US
Telephone Number	:	916-451-0858
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 J ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-2605
Country	:	US
Telephone Number	:	916-278-5056
Fax Number	:	916-278-5053

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/08/2007

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