MEDICARE: CLIFFORD EXANTUS PT

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	PT22047	FL

General Provider Information

NPI Number	:	1144591454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFFORD EXANTUS PT

Provider Business Mailing Address
First Line	:	4641 OLD CANOE CREEK RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-1550
Country	:	US
Telephone Number	:	407-892-7344
Fax Number	:

Provider Business Practice Location Address
First Line	:	4641 OLD CANOE CREEK RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-1550
Country	:	US
Telephone Number	:	407-892-7334
Fax Number	:

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

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	01/18/2014

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