MEDICARE: TRAILS PHYSICAL THERAPY

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	PT20328	CA

General Provider Information

NPI Number	:	1922490895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAILS PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	6717 MURRAY PARK DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-3911
Country	:	US
Telephone Number	:	858-692-5835
Fax Number	:	619-825-7500

Provider Business Practice Location Address
First Line	:	7676 JACKSON DR STE 4
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1515
Country	:	US
Telephone Number	:	858-692-5835
Fax Number	:	619-825-7500

Authorized Official
Title or Position	:	OWNER/ PHYSICAL THERAPIST
Name	:	MR. DARREN SHAUN WILLIAMS
Credential	:	P.T.
Telephone Number	:	858-692-5835

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	03/02/2015

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Directions to “TRAILS PHYSICAL THERAPY ” Practice Location

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