MEDICARE: ROYAL PALM PHYSICAL THERAPY GROUP

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	2675	AZ

General Provider Information

NPI Number	:	1093985020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL PALM PHYSICAL THERAPY GROUP

Provider Business Mailing Address
First Line	:	918 W ROYAL PALM RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5657
Country	:	US
Telephone Number	:	602-358-8883
Fax Number	:

Provider Business Practice Location Address
First Line	:	918 W ROYAL PALM RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5657
Country	:	US
Telephone Number	:	602-358-8883
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEAN J MICALIZIO
Credential	:	P.T.
Telephone Number	:	602-358-8883

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	03/05/2008

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