MEDICARE: PT MEDICAL, 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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1992032346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PT MEDICAL, INC

Provider Business Mailing Address
First Line	:	250 PRESIDENT ST STE 2300
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4663
Country	:	US
Telephone Number	:	443-320-1023
Fax Number	:	443-320-1030

Provider Business Practice Location Address
First Line	:	5731 W SLAUSON AVE STE 150
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4232
Country	:	US
Telephone Number	:	443-320-1023
Fax Number	:	443-320-1030

Authorized Official
Title or Position	:	CFO
Name	:	CRAIG BARTLETT
Credential	:
Telephone Number	:	443-320-1023

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	11/05/2009

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