MEDICARE: UDUAK EKPO MSPT

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	21486	FL

General Provider Information

NPI Number	:	1518028802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UDUAK EKPO MSPT

Provider Business Mailing Address
First Line	:	1731 NE 172ND ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1533
Country	:	US
Telephone Number	:	954-895-9291
Fax Number	:	305-249-5477

Provider Business Practice Location Address
First Line	:	1731 NE 172 STREET
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162
Country	:	US
Telephone Number	:	954-895-9291
Fax Number	:	305-249-5477

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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