MEDICARE: NEW SMYRNA BEACH PHYSICAL THERAPY LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639845282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW SMYRNA BEACH PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	701 E 3RD AVE UNIT 6
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-3104
Country	:	US
Telephone Number	:	386-957-3902
Fax Number	:	386-232-9761

Provider Business Practice Location Address
First Line	:	701 E 3RD AVE UNIT 6
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32169-3104
Country	:	US
Telephone Number	:	386-957-3902
Fax Number	:	386-232-9761

Authorized Official
Title or Position	:	OWNER
Name	:	ALLYSON KIGHT
Credential	:	DPT
Telephone Number	:	703-489-7597

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	07/27/2022

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