MEDICARE: KATIE ALICIA LEHNER 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	PT38759	CA

General Provider Information

NPI Number	:	1972861862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE ALICIA LEHNER DPT

Provider Business Mailing Address
First Line	:	3639 MIDWAY DR STE B286
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5254
Country	:	US
Telephone Number	:	858-488-3597
Fax Number	:	858-746-4041

Provider Business Practice Location Address
First Line	:	818 SIXTH STREET
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92118
Country	:	US
Telephone Number	:	858-488-3597
Fax Number	:	858-746-4041

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

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/27/2012

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