MEDICARE: NANCY RUTH KOILES MPT

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	PT19234	FL

General Provider Information

NPI Number	:	1366596819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY RUTH KOILES MPT

Provider Business Mailing Address
First Line	:	660 GLADES RD STE 460
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-6469
Country	:	US
Telephone Number	:	561-391-5515
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 GLADES RD STE 460
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-6469
Country	:	US
Telephone Number	:	561-391-5515
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	03/28/2024

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