MEDICARE: FAMILY PHYSICAL THERAPY CENTER

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	261QP2000X	Physical Therapy Clinic/Center	PT0005096	FL

General Provider Information

NPI Number	:	1235324005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PHYSICAL THERAPY CENTER

Provider Business Mailing Address
First Line	:	704 W LUMSDEN RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-6260
Country	:	US
Telephone Number	:	813-654-3808
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 W LUMSDEN RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-6260
Country	:	US
Telephone Number	:	813-654-3808
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JANIESSE O RIVERA
Credential	:	P.T
Telephone Number	:	813-654-3808

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	02/04/2008

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