MEDICARE: SOUTH COAST 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	305R00000X	Preferred Provider Organization	RPT0004946	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134274749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH COAST PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	4999 W 8TH AVE
Second Line	:	SUITE 6
City	:	HIALEAH
State	:	FL
Zip	:	33012-3409
Country	:	US
Telephone Number	:	305-821-0100
Fax Number	:	305-821-0808

Provider Business Practice Location Address
First Line	:	4999 W 8TH AVE
Second Line	:	SUITE 6
City	:	HIALEAH
State	:	FL
Zip	:	33012-3409
Country	:	US
Telephone Number	:	305-821-0100
Fax Number	:	305-821-0808

Authorized Official
Title or Position	:	PHYSICAL THERAPY PRESIDENT
Name	:	RASSOUL ABTAHI
Credential	:	305 8210100
Telephone Number	:	305-821-0100

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	12/20/2007

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Directions to “SOUTH COAST PHYSICAL THERAPY INC ” Practice Location

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