MEDICARE: AZRA M HAKIM 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	PT 22812	FL

General Provider Information

NPI Number	:	1518098482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZRA M HAKIM MSPT

Provider Business Mailing Address
First Line	:	2942 DREW ST
Second Line	:	APT 1515
City	:	CLEARWATER
State	:	FL
Zip	:	33759-3059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6613 49TH ST
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-5728
Country	:	US
Telephone Number	:	727-527-2100
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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