MEDICARE: JOSEPH GUNNAR FILLERUP P.T.

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	292382	CA

General Provider Information

NPI Number	:	1992247365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH GUNNAR FILLERUP P.T.

Provider Business Mailing Address
First Line	:	2324 BONITA AVE
Second Line	:
City	:	LA VERNE
State	:	CA
Zip	:	91750-4931
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 N LAKE AVE
Second Line	:	SUITE 201
City	:	PASADENA
State	:	CA
Zip	:	91101-4107
Country	:	US
Telephone Number	:	626-568-9115
Fax Number	:

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

Provider Enumeration Date	:	11/16/2016
Last Update Date	:	04/28/2023

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