MEDICARE: POSITIVE ENERGY PHYSICAL THERAPY INC

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	29414	CA

General Provider Information

NPI Number	:	1992001341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE ENERGY PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	1912 S PACIFIC COAST HWY
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-6118
Country	:	US
Telephone Number	:	310-540-5758
Fax Number	:	310-540-5404

Provider Business Practice Location Address
First Line	:	1912 S PACIFIC COAST HWY
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-6118
Country	:	US
Telephone Number	:	310-540-5758
Fax Number	:	310-540-5404

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SEAN RYAN
Credential	:	PT
Telephone Number	:	310-654-9500

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	02/02/2011

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