MEDICARE: MS. TERRI ANN MCMAINS 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	2251G0304X	Geriatric Physical Therapist	8047	CA

General Provider Information

NPI Number	:	1972658763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERRI ANN MCMAINS PT,DPT

Provider Business Mailing Address
First Line	:	PO BOX 57
Second Line	:	53 WEST PALO ALTO AVENUE
City	:	OCOTILLO
State	:	CA
Zip	:	92259
Country	:	US
Telephone Number	:	760-554-1244
Fax Number	:

Provider Business Practice Location Address
First Line	:	1528 S WATERMAN AVE
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4142
Country	:	US
Telephone Number	:	760-554-1244
Fax Number	:

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	12/20/2013

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