MEDICARE: MRS. PATRICIA TIPTON BRAY 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	PT0004138	FL

General Provider Information

NPI Number	:	1164623120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA TIPTON BRAY PT

Provider Business Mailing Address
First Line	:	24037 PALM AVE
Second Line	:
City	:	HOWEY IN THE HILLS
State	:	FL
Zip	:	34737-3924
Country	:	US
Telephone Number	:	407-296-1901
Fax Number	:	407-253-2515

Provider Business Practice Location Address
First Line	:	24037 PALM AVE
Second Line	:
City	:	HOWEY IN THE HILLS
State	:	FL
Zip	:	34737-3924
Country	:	US
Telephone Number	:	407-296-1000
Fax Number	:	407-253-2515

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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