MEDICARE: MRS. MORRETTE SOPHIA NICHOLAS-KARL PHYSICAL THERAPIST

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	PT23434	FL

General Provider Information

NPI Number	:	1407040124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MORRETTE SOPHIA NICHOLAS-KARL PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	2252 WAYCROSS RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-2743
Country	:	US
Telephone Number	:	513-742-2333
Fax Number	:	513-742-0943

Provider Business Practice Location Address
First Line	:	6432 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3008
Country	:	US
Telephone Number	:	561-433-1884
Fax Number	:	561-433-1885

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

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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