MEDICARE: PHYSIOKINETICS 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1003097007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSIOKINETICS INC

Provider Business Mailing Address
First Line	:	4393 LAKE TAHOE CIR
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33409-7872
Country	:	US
Telephone Number	:	561-616-7664
Fax Number	:

Provider Business Practice Location Address
First Line	:	4393 LAKE TAHOE CIR
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33409-7872
Country	:	US
Telephone Number	:	561-616-7664
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MR. GREGORY MARK ROSE
Credential	:	PT
Telephone Number	:	561-616-7664

Provider Enumeration Date	:	11/18/2007
Last Update Date	:	02/14/2008

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Directions to “PHYSIOKINETICS INC ” Practice Location

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