MEDICARE: MS. AUDREY IRONSIDE P.T.

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	10651	FL

General Provider Information

NPI Number	:	1184674368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AUDREY IRONSIDE P.T.

Provider Business Mailing Address
First Line	:	1782 TUDOR RD
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-2435
Country	:	US
Telephone Number	:	561-775-6332
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 BURNS RD
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-5207
Country	:	US
Telephone Number	:	561-627-4427
Fax Number	:	561-627-2798

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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