MEDICARE: PHYSICAL THERAPY AND REHABILITATION ASSOCIATES 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	PT19361	FL

General Provider Information

NPI Number	:	1962572917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY AND REHABILITATION ASSOCIATES INC.

Provider Business Mailing Address
First Line	:	900 RIVER REACH DR APT 110
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-1164
Country	:	US
Telephone Number	:	954-701-0528
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 RIVER REACH DR APT 110
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33315-1164
Country	:	US
Telephone Number	:	954-701-0528
Fax Number	:

Authorized Official
Title or Position	:	OWNER-PHYSICAL THERAPIST
Name	:	ANTHONY J BULLEN
Credential	:	MSPT
Telephone Number	:	954-701-0528

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	06/22/2009

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