MEDICARE: HEALING BODY & SOUL PHYSICAL THERAPY

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

General Provider Information

NPI Number	:	1255069365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING BODY & SOUL PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	5619 SILVER OAK DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-3268
Country	:	US
Telephone Number	:	305-742-8401
Fax Number	:

Provider Business Practice Location Address
First Line	:	5619 SILVER OAK DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-3268
Country	:	US
Telephone Number	:	305-742-8401
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ PTA
Name	:	TATIANA YISSEL RODRIGUEZ
Credential	:	PTA
Telephone Number	:	305-742-8401

Provider Enumeration Date	:	08/08/2022
Last Update Date	:	08/08/2022

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Directions to “HEALING BODY & SOUL PHYSICAL THERAPY ” Practice Location

Language	Start Address	Practice Location

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