MEDICARE: EDWIN VIJAYAN

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	32016	FL

General Provider Information

NPI Number	:	1811439276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN VIJAYAN

Provider Business Mailing Address
First Line	:	13645 BISCAYNE BLVD
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33181-1617
Country	:	US
Telephone Number	:	305-949-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	13645 BISCAYNE BLVD
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33181-1617
Country	:	US
Telephone Number	:	305-949-2700
Fax Number	:

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

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/15/2016

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