MEDICARE: MICHAEL WEISS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT22569	OTHER	FL	LICENSE #

General Provider Information

NPI Number	:	1265541718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WEISS

Provider Business Mailing Address
First Line	:	1085 KANE CONCOURSE
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2105
Country	:	US
Telephone Number	:	305-866-4664
Fax Number	:

Provider Business Practice Location Address
First Line	:	1085 KANE CONCOURSE
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-2105
Country	:	US
Telephone Number	:	305-866-4664
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	12/15/2010

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Directions to “ MICHAEL WEISS ” Practice Location

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