MEDICARE: PALM CITY PHYSICAL THERAPY, INC.

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	PT2232	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y907J	OTHER	FL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1487710513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM CITY PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	2684 SW IMMANUEL DR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2738
Country	:	US
Telephone Number	:	772-220-3444
Fax Number	:	772-220-3839

Provider Business Practice Location Address
First Line	:	2684 SW IMMANUEL DR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-2738
Country	:	US
Telephone Number	:	772-220-3444
Fax Number	:	772-220-3839

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MS. KAY KEELING DEERMAN
Credential	:	PT
Telephone Number	:	772-220-3444

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	08/22/2020

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