MEDICARE: MR. MICHAEL B RAIMONDI PTA

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	225200000X	Physical Therapy Assistant	PTA19951	FL

General Provider Information

NPI Number	:	1982949772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL B RAIMONDI PTA

Provider Business Mailing Address
First Line	:	5370 GALAMBOS ST
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34291-4745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5370 GALAMBOS ST
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34291-4745
Country	:	US
Telephone Number	:	941-525-7708
Fax Number	:

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

Provider Enumeration Date	:	12/05/2012
Last Update Date	:	12/05/2012

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