MEDICARE: MS. LORI ANNE FROST PTA

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	225200000X	Physical Therapy Assistant	PTA 17276	FL

General Provider Information

NPI Number	:	1023397445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI ANNE FROST PTA

Provider Business Mailing Address
First Line	:	2256 QUAIL RDG N
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3532
Country	:	US
Telephone Number	:	561-625-6983
Fax Number	:	561-630-4091

Provider Business Practice Location Address
First Line	:	2256 QUAIL RDG N
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3532
Country	:	US
Telephone Number	:	561-625-6983
Fax Number	:	561-630-4091

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

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	08/16/2011

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