MEDICARE: AMY GABRIELLE GERIAK MPT

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	25892	CA

General Provider Information

NPI Number	:	1962545236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY GABRIELLE GERIAK MPT

Provider Business Mailing Address
First Line	:	13926 SAN ANTONIO DR
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-4035
Country	:	US
Telephone Number	:	213-500-6786
Fax Number	:

Provider Business Practice Location Address
First Line	:	11500 W OLYMPIC BLVD
Second Line	:	SUITE 350
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1524
Country	:	US
Telephone Number	:	310-473-8287
Fax Number	:	310-477-3909

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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