MEDICARE: MR. TODD ROBERT JAMES PT

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	PT19854	FL

General Provider Information

NPI Number	:	1073562369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD ROBERT JAMES PT

Provider Business Mailing Address
First Line	:	8632 NW 62ND PL
Second Line	:
City	:	PARKLAND
State	:	FL
Zip	:	33067-5024
Country	:	US
Telephone Number	:	954-341-4872
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 LYONS RD
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33063-3927
Country	:	US
Telephone Number	:	954-972-1200
Fax Number	:	954-972-6212

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	02/16/2024

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