MEDICARE: MR. DAVID MARK VOELLINGER MSPT

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	PT7484	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6697041	OTHER		GHI

General Provider Information

NPI Number	:	1053410472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID MARK VOELLINGER MSPT

Provider Business Mailing Address
First Line	:	6169 JOG ROAD
Second Line	:	SUITE A 11
City	:	LAKE WORTH
State	:	FL
Zip	:	33467
Country	:	US
Telephone Number	:	561-432-0111
Fax Number	:	561-432-1075

Provider Business Practice Location Address
First Line	:	11000 PROSPERITY FARMS RD
Second Line	:	SUITE 203
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-3462
Country	:	US
Telephone Number	:	561-432-0111
Fax Number	:	561-432-1075

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	11/28/2011

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