MEDICARE: SUNRISE PHYSICAL THERAPY AND REHAB, 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	225100000X	Physical Therapist	7481	FL
2	225100000X	Physical Therapist	8860	FL

General Provider Information

NPI Number	:	1205889714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE PHYSICAL THERAPY AND REHAB, INC

Provider Business Mailing Address
First Line	:	1501 PRESIDENTIAL WAY STE 20
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-1852
Country	:	US
Telephone Number	:	561-684-6811
Fax Number	:	561-684-6812

Provider Business Practice Location Address
First Line	:	1501 PRESIDENTIAL WAY STE 20
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-1852
Country	:	US
Telephone Number	:	561-684-6811
Fax Number	:	561-684-6812

Authorized Official
Title or Position	:	PT/VP
Name	:	MR. BENSON P BAGASAN
Credential	:	PT
Telephone Number	:	561-732-2422

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	11/20/2008

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