MEDICARE: STOCKTON PHYSICAL THERAPY AND LYMPHEDEMA CLINIC, 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	261QP2000X	Physical Therapy Clinic/Center	PT25932	CA

General Provider Information

NPI Number	:	1992990865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STOCKTON PHYSICAL THERAPY AND LYMPHEDEMA CLINIC, INC

Provider Business Mailing Address
First Line	:	221 TUXEDO CT
Second Line	:	SUITE - B
City	:	STOCKTON
State	:	CA
Zip	:	95204-5261
Country	:	US
Telephone Number	:	209-464-0200
Fax Number	:	209-464-0220

Provider Business Practice Location Address
First Line	:	221 TUXEDO CT
Second Line	:	SUITE - B
City	:	STOCKTON
State	:	CA
Zip	:	95204-5261
Country	:	US
Telephone Number	:	209-464-0200
Fax Number	:	209-464-0220

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	VIRTU ARORA
Credential	:	PT
Telephone Number	:	209-464-0200

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	04/10/2009

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