MEDICARE: PRO PT, INC.

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	3050	OR

General Provider Information

NPI Number	:	1922244870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO PT, INC.

Provider Business Mailing Address
First Line	:	2846 EBERLEIN AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4402
Country	:	US
Telephone Number	:	541-850-8909
Fax Number	:	541-882-4005

Provider Business Practice Location Address
First Line	:	2846 EBERLEIN AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4402
Country	:	US
Telephone Number	:	541-850-8909
Fax Number	:	541-882-4005

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	BRENDA SUE TOSCHIK
Credential	:	PT
Telephone Number	:	541-850-8909

Provider Enumeration Date	:	12/24/2008
Last Update Date	:	12/24/2008

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