MEDICARE: CLEAR CHOICE PHYSICAL THERAPY, INC.

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	:	1205078656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR CHOICE PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	6501 NE 21ST LN
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-1005
Country	:	US
Telephone Number	:	954-772-1742
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 NE 21ST LN
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-1005
Country	:	US
Telephone Number	:	954-772-1742
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ERIK BLEEKER
Credential	:	P.T.
Telephone Number	:	954-772-1742

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	04/01/2009

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