MEDICARE: MRS. WENDY URSO 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	PT 13607	FL

General Provider Information

NPI Number	:	1215938667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY URSO PT

Provider Business Mailing Address
First Line	:	2035 N UNIVERSITY DR
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33322-3936
Country	:	US
Telephone Number	:	954-478-4648
Fax Number	:	954-530-5694

Provider Business Practice Location Address
First Line	:	2035 N UNIVERSITY DR
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33322-3936
Country	:	US
Telephone Number	:	954-478-4648
Fax Number	:	954-530-5694

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/27/2013

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