MEDICARE: ABBY MEARS 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	PT33849	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT33849	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1225510100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY MEARS PT

Provider Business Mailing Address
First Line	:	3903 NORTHDALE BLVD STE 111W
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1853
Country	:	US
Telephone Number	:	172-747-5540
Fax Number	:

Provider Business Practice Location Address
First Line	:	3180 CURLEW RD UNIT 102
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-2629
Country	:	US
Telephone Number	:	813-343-4840
Fax Number	:	866-277-6214

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

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	09/06/2018

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