MEDICARE: EWING AND THOMAS, 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	PT736	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	:	1063400265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EWING AND THOMAS, INC.

Provider Business Mailing Address
First Line	:	5311 GRAND BLVD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4014
Country	:	US
Telephone Number	:	727-848-3962
Fax Number	:	727-848-7028

Provider Business Practice Location Address
First Line	:	5311 GRAND BLVD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4014
Country	:	US
Telephone Number	:	727-848-3962
Fax Number	:	727-848-7028

Authorized Official
Title or Position	:	PRESIDENT/PHYSICAL THERAPIST
Name	:	MR. JOHANNES WIJNMAALEN
Credential	:
Telephone Number	:	727-848-3962

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	01/24/2014

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