MEDICARE: SCOTT SHURPIN CPT LMT

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	172M00000X	Mechanotherapist	MA 18217	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA 18217	OTHER		I HAVE MY LICENSE NUMBER.

General Provider Information

NPI Number	:	1013238070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT SHURPIN CPT LMT

Provider Business Mailing Address
First Line	:	201 SE 15TH TER
Second Line	:	SUITE 201
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4464
Country	:	US
Telephone Number	:	954-591-0552
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 SE 15TH TER
Second Line	:	SUITE 201
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4464
Country	:	US
Telephone Number	:	954-591-0552
Fax Number	:

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

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	06/14/2010

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