MEDICARE: MR. WILLIAM THOMAS RAND JR. 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	20689	FL

General Provider Information

NPI Number	:	1134153976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM THOMAS RAND JR. P.T.

Provider Business Mailing Address
First Line	:	15504 ARIBE AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33981-4251
Country	:	US
Telephone Number	:	941-697-1839
Fax Number	:

Provider Business Practice Location Address
First Line	:	3089 TAMIAMI TRAIL
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952
Country	:	US
Telephone Number	:	941-662-0196
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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