MEDICARE: MARCUS CANTU PT, DPT

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	PTH6243	AL

General Provider Information

NPI Number	:	1932476314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCUS CANTU PT, DPT

Provider Business Mailing Address
First Line	:	2470 ROCKY RIDGE RD STE 102
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-2833
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2470 ROCKY RIDGE RD STE 102
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-2833
Country	:	US
Telephone Number	:	205-824-4525
Fax Number	:

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

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	07/25/2014

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