MEDICARE: MICHAEL DANA MCINTOSH PT

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	2004015329	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982632576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DANA MCINTOSH PT

Provider Business Mailing Address
First Line	:	14899 TAMIAMI TRL STE 200
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-2732
Country	:	US
Telephone Number	:	561-688-1844
Fax Number	:	561-688-1845

Provider Business Practice Location Address
First Line	:	14899 TAMIAMI TRL STE 200
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34287-2732
Country	:	US
Telephone Number	:	561-688-1844
Fax Number	:	561-688-1845

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	02/04/2019

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