MEDICARE: VENUS MAULDIN 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	PT21179	FL

General Provider Information

NPI Number	:	1215148432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENUS MAULDIN PT

Provider Business Mailing Address
First Line	:	1606 FRUITWOOD DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-2425
Country	:	US
Telephone Number	:	727-254-3964
Fax Number	:

Provider Business Practice Location Address
First Line	:	2349 SUNSET POINT RD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-1456
Country	:	US
Telephone Number	:	727-723-8457
Fax Number	:

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

Provider Enumeration Date	:	05/28/2007
Last Update Date	:	11/30/2018

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