MEDICARE: PROSTAR PHYSICAL THERAPY, LLC

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	PT5627	FL

General Provider Information

NPI Number	:	1023312535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTAR PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	4533 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6611
Country	:	US
Telephone Number	:	954-342-1177
Fax Number	:	954-510-0138

Provider Business Practice Location Address
First Line	:	4533 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6611
Country	:	US
Telephone Number	:	954-342-1177
Fax Number	:	954-510-0138

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. RICHARD J KRAMER
Credential	:	PT
Telephone Number	:	954-342-1177

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	04/20/2011

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