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NPI Code Detail

MEDICARE: PETER MODERA DPT

MEDICARE: PETER MODERA DPT
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
12251X0800XOrthopedic Physical TherapistPT34695FL

General Provider Information

NPI Number : 1255943882
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER MODERA DPT
Provider Business Mailing Address
First Line : 910 MACY ST
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33405-3810
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1115 E SUNRISE BLVD
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33304-2809
Country : US
Telephone Number : 954-247-4929
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2020
Last Update Date : 08/17/2020

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Directions to “ PETER MODERA DPT” Practice Location

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