MEDICARE: BACK IN ACTION

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	261Q00000X	Clinic/Center	PT4144	FL

General Provider Information

NPI Number	:	1083778682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK IN ACTION

Provider Business Mailing Address
First Line	:	4022 N OCEAN BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308
Country	:	US
Telephone Number	:	954-567-2617
Fax Number	:	954-567-2819

Provider Business Practice Location Address
First Line	:	4022 N OCEAN BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308
Country	:	US
Telephone Number	:	954-567-2617
Fax Number	:	954-567-2819

Authorized Official
Title or Position	:	DIRECTOR PHYSICAL THERAPY
Name	:	MRS. LYDIA T. BRADLEY
Credential	:	RPT
Telephone Number	:	954-567-2617

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	08/30/2007

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Directions to “BACK IN ACTION ” Practice Location

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