MEDICARE: FLORIDA THERAPY CENTER OF INDIAN HARBOUR BEACH, LLC

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		FL

General Provider Information

NPI Number	:	1134361561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA THERAPY CENTER OF INDIAN HARBOUR BEACH, LLC

Provider Business Mailing Address
First Line	:	2060 HIGHWAY A1A STE 306
Second Line	:
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-3596
Country	:	US
Telephone Number	:	321-773-1778
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 HIGHWAY A1A STE 306
Second Line	:
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-3596
Country	:	US
Telephone Number	:	321-773-1778
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. MATHEW KRONMAN
Credential	:	MPT
Telephone Number	:	321-773-1778

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	07/29/2009

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