MEDICARE: FLORIDA MOVEMENT THERAPY CENTER-BOYNTON BEACH 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	225X00000X	Occupational Therapist	OT 9734	FL
2	225100000X	Physical Therapist	PT 3436	FL

General Provider Information

NPI Number	:	1013105196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA MOVEMENT THERAPY CENTER-BOYNTON BEACH INC

Provider Business Mailing Address
First Line	:	12040 S JOG RD
Second Line	:	SUITE #8
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-4164
Country	:	US
Telephone Number	:	561-733-5083
Fax Number	:

Provider Business Practice Location Address
First Line	:	12040 S JOG RD
Second Line	:	SUITE 8
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-4164
Country	:	US
Telephone Number	:	561-733-5083
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EDWARD PATRICK GRAY
Credential	:	OTR/L-PTA
Telephone Number	:	561-733-5083

Provider Enumeration Date	:	10/14/2007
Last Update Date	:	10/23/2015

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