MEDICARE: CORE VALUES PHYSICAL THERAPY AND WELLNESS, PLLC

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

General Provider Information

NPI Number	:	1134781966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE VALUES PHYSICAL THERAPY AND WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	8844 RIBAULT AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-4914
Country	:	US
Telephone Number	:	954-895-1810
Fax Number	:

Provider Business Practice Location Address
First Line	:	6765 NARCOOSSEE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-5508
Country	:	US
Telephone Number	:	407-476-6613
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PHYSICAL THERAPIST
Name	:	REBECCA L SMITH
Credential	:
Telephone Number	:	407-476-6613

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	07/02/2019

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