MEDICARE: TREVOR LLOYD HARLAN PTA

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	225200000X	Physical Therapy Assistant	PTA27884	FL

General Provider Information

NPI Number	:	1164932182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR LLOYD HARLAN PTA

Provider Business Mailing Address
First Line	:	4 HARVARD CIR STE 700
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1989
Country	:	US
Telephone Number	:	561-684-9200
Fax Number	:	561-684-9202

Provider Business Practice Location Address
First Line	:	4 HARVARD CIR STE 700
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1989
Country	:	US
Telephone Number	:	561-685-9200
Fax Number	:

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

Provider Enumeration Date	:	10/04/2017
Last Update Date	:	10/04/2017

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