MEDICARE: BODY KINETICS OF FLORIDA 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	PT13787	FL

General Provider Information

NPI Number	:	1235229188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY KINETICS OF FLORIDA INC

Provider Business Mailing Address
First Line	:	2151 E COMMERCIAL BLVD
Second Line	:	SUITE 305
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-3807
Country	:	US
Telephone Number	:	954-958-9262
Fax Number	:	954-958-9263

Provider Business Practice Location Address
First Line	:	2151 E COMMERCIAL BLVD
Second Line	:	SUITE 305
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-3807
Country	:	US
Telephone Number	:	954-958-9262
Fax Number	:	954-958-9263

Authorized Official
Title or Position	:	OWNER
Name	:	PAMELA MORTEMORE
Credential	:
Telephone Number	:	954-958-9262

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	08/22/2020

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