MEDICARE: PETER MIDURA

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	PT35216	FL

General Provider Information

NPI Number	:	1063057958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER MIDURA

Provider Business Mailing Address
First Line	:	2086 CHAGALL CIR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-7524
Country	:	US
Telephone Number	:	413-455-5453
Fax Number	:

Provider Business Practice Location Address
First Line	:	2670 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5972
Country	:	US
Telephone Number	:	561-968-9100
Fax Number	:

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

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	11/14/2019

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Directions to “ PETER MIDURA ” Practice Location

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