MEDICARE: MRS. MARY SUSAN NEWTON-TOWERS 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	172V00000X	Community Health Worker	7505	CA

General Provider Information

NPI Number	:	1912175068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY SUSAN NEWTON-TOWERS P.T.

Provider Business Mailing Address
First Line	:	1527 PRISCILLA LN
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-4440
Country	:	US
Telephone Number	:	949-548-7939
Fax Number	:	949-548-5985

Provider Business Practice Location Address
First Line	:	1527 PRISCILLA LN
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-4440
Country	:	US
Telephone Number	:	949-548-7939
Fax Number	:	949-548-5985

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

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	02/12/2008

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