MEDICARE: OLIVER CONCEPCION FLORES 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	2251G0304X	Geriatric Physical Therapist	12107	FL

General Provider Information

NPI Number	:	1225074537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVER CONCEPCION FLORES PT

Provider Business Mailing Address
First Line	:	7775 MOKENA CT
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-5647
Country	:	US
Telephone Number	:	727-723-5480
Fax Number	:	727-849-5355

Provider Business Practice Location Address
First Line	:	7775 MOKENA CT
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-5647
Country	:	US
Telephone Number	:	727-723-5480
Fax Number	:	727-849-5355

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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