MEDICARE: MATTHEW FREDERICK HIRSCH PT

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	PT011103	GA
2	225100000X	Physical Therapist	PT 28750	FL

General Provider Information

NPI Number	:	1134551047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW FREDERICK HIRSCH PT

Provider Business Mailing Address
First Line	:	2929 BIARRITZ DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-1419
Country	:	US
Telephone Number	:	912-713-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 LAKE WORTH RD
Second Line	:	SUITE C
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3694
Country	:	US
Telephone Number	:	561-968-7788
Fax Number	:	561-968-9969

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

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	08/04/2014

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