MEDICARE: NEXTGEN PHYSICAL THERAPY, P.A.

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	PT29193	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053716647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXTGEN PHYSICAL THERAPY, P.A.

Provider Business Mailing Address
First Line	:	7358 SW 107TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-2715
Country	:	US
Telephone Number	:	786-534-9846
Fax Number	:	786-534-7246

Provider Business Practice Location Address
First Line	:	7358 SW 107TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-2715
Country	:	US
Telephone Number	:	786-534-9846
Fax Number	:	786-534-7246

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAVIER A OBREGON
Credential	:	DPT
Telephone Number	:	786-534-9846

Provider Enumeration Date	:	10/26/2014
Last Update Date	:	01/23/2015

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