MEDICARE: ELIZABETH LEWIS DEVINE DPT

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	30270	FL

General Provider Information

NPI Number	:	1467826842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LEWIS DEVINE DPT

Provider Business Mailing Address
First Line	:	10800 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2533
Country	:	US
Telephone Number	:	850-249-5402
Fax Number	:

Provider Business Practice Location Address
First Line	:	10800 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2533
Country	:	US
Telephone Number	:	850-249-5402
Fax Number	:

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

Provider Enumeration Date	:	11/22/2015
Last Update Date	:	11/22/2015

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