MEDICARE: SANDY TOES PEDIATRIC PHYSICAL THERAPY

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

General Provider Information

NPI Number	:	1710598362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDY TOES PEDIATRIC PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	3865 HIDDEN HILLS DR
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-2972
Country	:	US
Telephone Number	:	717-891-7555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3865 HIDDEN HILLS DR
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-2972
Country	:	US
Telephone Number	:	717-891-7555
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RACHEL L WILLIAMS
Credential	:	PT
Telephone Number	:	717-891-7555

Provider Enumeration Date	:	08/16/2020
Last Update Date	:	08/16/2020

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Directions to “SANDY TOES PEDIATRIC PHYSICAL THERAPY ” Practice Location

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