MEDICARE: WESTCHASE PHYSICAL THERAPY AND MEDICAL SUPPLY LLC

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	174400000X	Specialist
2	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7776919	OTHER	FL	AETNA
2	Y924J	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1114083946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTCHASE PHYSICAL THERAPY AND MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	12705 RACE TRACK RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1314
Country	:	US
Telephone Number	:	813-343-3960
Fax Number	:	813-343-3965

Provider Business Practice Location Address
First Line	:	12705 RACE TRACK RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1314
Country	:	US
Telephone Number	:	813-343-3960
Fax Number	:	813-343-3965

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN MAGEE
Credential	:	DPT
Telephone Number	:	813-343-3960

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/26/2022

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