MEDICARE: CHARLES W. NEWBY P.T.

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	2298	AL
2	225100000X	Physical Therapist	PT20271	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1114975703	OTHER	FL	NPI
2	51524069	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1114975703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES W. NEWBY P.T.

Provider Business Mailing Address
First Line	:	1944 N HERCULES AVE STE C
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763-4403
Country	:	US
Telephone Number	:	727-797-8100
Fax Number	:	727-797-8110

Provider Business Practice Location Address
First Line	:	1944 N HERCULES AVE STE C
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763-4403
Country	:	US
Telephone Number	:	727-797-8100
Fax Number	:	727-797-8110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	01/10/2011

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Directions to “ CHARLES W. NEWBY P.T.” Practice Location

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