MEDICARE: MS. REBECCA T LATRAVERSE PT, 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	PT26859	FL

General Provider Information

NPI Number	:	1699108985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA T LATRAVERSE PT, DPT

Provider Business Mailing Address
First Line	:	314 SCOTT CT
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-4645
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4470 E BAY DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-5772
Country	:	US
Telephone Number	:	727-530-7100
Fax Number	:

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

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	08/09/2013

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