MEDICARE: WORTH PHYSICAL THERAPY, 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	261QP2000X	Physical Therapy Clinic/Center	HCC3954	FL

General Provider Information

NPI Number	:	1114957453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORTH PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	7111 LAKE WORTH RD # 15
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2906
Country	:	US
Telephone Number	:	561-966-7950
Fax Number	:	561-514-8346

Provider Business Practice Location Address
First Line	:	7111 LAKE WORTH RD # 15
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2906
Country	:	US
Telephone Number	:	561-966-7950
Fax Number	:	561-514-8346

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL LEOPOLD
Credential	:	PT
Telephone Number	:	561-966-7950

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	06/24/2008

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