MEDICARE: BROWARD MANUAL REHAB 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	PT 19201	FL

General Provider Information

NPI Number	:	1710106190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWARD MANUAL REHAB INC

Provider Business Mailing Address
First Line	:	4959 N STATE ROAD 7
Second Line	:	STE D
City	:	TAMARAC
State	:	FL
Zip	:	33319-5871
Country	:	US
Telephone Number	:	954-717-1983
Fax Number	:	954-717-1984

Provider Business Practice Location Address
First Line	:	4959 N STATE ROAD 7
Second Line	:	STE D
City	:	TAMARAC
State	:	FL
Zip	:	33319-5871
Country	:	US
Telephone Number	:	954-717-1983
Fax Number	:	954-717-1984

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIMITRI COSMIOS
Credential	:	P.T.
Telephone Number	:	954-717-1983

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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