MEDICARE: ROBERT LANGSTON TUGWELL P.T.

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	19739	FL

General Provider Information

NPI Number	:	1811163181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT LANGSTON TUGWELL P.T.

Provider Business Mailing Address
First Line	:	15 IVEY LN
Second Line	:
City	:	FLAGLER BEACH
State	:	FL
Zip	:	32136-4935
Country	:	US
Telephone Number	:	386-517-0025
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 S BEACH ST
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4408
Country	:	US
Telephone Number	:	386-295-0753
Fax Number	:

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

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	05/06/2008

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