MEDICARE: KISHNA SLOAN

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	18059	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	102323279	OTHER	FL	INDIVIDUAL NPI NUMBER

General Provider Information

NPI Number	:	1215177514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KISHNA SLOAN

Provider Business Mailing Address
First Line	:	7403 BRIELLA DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3769
Country	:	US
Telephone Number	:	561-704-7224
Fax Number	:	561-509-8841

Provider Business Practice Location Address
First Line	:	7403 BRIELLA DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-3769
Country	:	US
Telephone Number	:	561-704-7224
Fax Number	:	561-509-8841

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MS. KISHNA NICOLE SLOAN
Credential	:	P.T.
Telephone Number	:	561-704-7224

Provider Enumeration Date	:	02/25/2009
Last Update Date	:	07/17/2009

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Directions to “KISHNA SLOAN ” Practice Location

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