MEDICARE: JOHANNE ANDRE KALILE PA

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	225100000X	Physical Therapist	PT9909	FL

General Provider Information

NPI Number	:	1023137262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHANNE ANDRE KALILE PA

Provider Business Mailing Address
First Line	:	1183 OAKWATER DR
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-6107
Country	:	US
Telephone Number	:	561-762-9731
Fax Number	:	561-214-4494

Provider Business Practice Location Address
First Line	:	1183 OAKWATER DR
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-6107
Country	:	US
Telephone Number	:	561-762-9731
Fax Number	:	561-214-4494

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MRS. JOHANNE ANDRE KALILE
Credential	:	PT
Telephone Number	:	561-762-9731

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	05/13/2008

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