MEDICARE: NILSA J. CHARLES R.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	PT6792	FL

General Provider Information

NPI Number	:	1881774230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NILSA J. CHARLES R.P.T.

Provider Business Mailing Address
First Line	:	309 STERLING LAKE DR
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4014
Country	:	US
Telephone Number	:	407-592-9106
Fax Number	:	407-445-4767

Provider Business Practice Location Address
First Line	:	309 STERLING LAKE DR
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4014
Country	:	US
Telephone Number	:	407-592-9106
Fax Number	:	407-445-4767

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/09/2007

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