=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083964068
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARNOT Q WADSWORTH IV P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2012
-----------------------------------------------------
Last Update Date | 09/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3360 BURNS RD
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-4323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-776-7833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6747 SW LIVE OAK LN
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34997-7431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-215-3557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT19680
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------