MEDICARE: MR. TARCISIO PANARES REYNES JR. LPT

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	PT 13515	FL

General Provider Information

NPI Number	:	1376712638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TARCISIO PANARES REYNES JR. LPT

Provider Business Mailing Address
First Line	:	7856 AMBLESIDE WAY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7348
Country	:	US
Telephone Number	:	561-963-9624
Fax Number	:

Provider Business Practice Location Address
First Line	:	7856 AMBLESIDE WAY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7348
Country	:	US
Telephone Number	:	561-963-9624
Fax Number	:

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	02/20/2008

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