MEDICARE: PHYSICAL THERAPY INSTITUTE AND AQUATIC REHAB, INC

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

General Provider Information

NPI Number	:	1073985768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY INSTITUTE AND AQUATIC REHAB, INC

Provider Business Mailing Address
First Line	:	4971 LE CHALET BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-1418
Country	:	US
Telephone Number	:	561-733-5590
Fax Number	:

Provider Business Practice Location Address
First Line	:	1047 S STATE ROAD 7 # 100
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-6135
Country	:	US
Telephone Number	:	561-733-5590
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN PAPA
Credential	:
Telephone Number	:	561-801-2535

Provider Enumeration Date	:	10/21/2015
Last Update Date	:	10/26/2018

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