MEDICARE: AUSTRALIAN PHYSIOTHERAPY SPECIALISTS, LLC

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	PT19660	FL

General Provider Information

NPI Number	:	1164776662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSTRALIAN PHYSIOTHERAPY SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	4745 SUTTON PARK CT
Second Line	:	SUITE 803
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-0250
Country	:	US
Telephone Number	:	904-337-1090
Fax Number	:	904-337-1093

Provider Business Practice Location Address
First Line	:	4745 SUTTON PARK CT
Second Line	:	SUITE 803
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-0250
Country	:	US
Telephone Number	:	904-337-1090
Fax Number	:	904-337-1093

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MR. MARROW BURNETTE
Credential	:
Telephone Number	:	904-403-3880

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	11/05/2012

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