MEDICARE: MR. ERIC MONAHAN P.T.A. / L.M.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	225200000X	Physical Therapy Assistant	PTA21169	FL
2	225700000X	Massage Therapist	MA37705	FL

General Provider Information

NPI Number	:	1215179940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC MONAHAN P.T.A. / L.M.T

Provider Business Mailing Address
First Line	:	1604 SEMINOLE PALMS DR
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-4229
Country	:	US
Telephone Number	:	561-767-1878
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 N STATE ROAD 7
Second Line	:	SUITE A
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-5184
Country	:	US
Telephone Number	:	561-784-3767
Fax Number	:

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

Provider Enumeration Date	:	03/26/2009
Last Update Date	:	11/10/2010

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