MEDICARE: MS. MARY CATHERINE MCGONE PTA

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	225200000X	Physical Therapy Assistant	PTA807	FL

General Provider Information

NPI Number	:	1265828453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY CATHERINE MCGONE PTA

Provider Business Mailing Address
First Line	:	2060 A1A HWY
Second Line	:
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-3596
Country	:	US
Telephone Number	:	321-890-7439
Fax Number	:

Provider Business Practice Location Address
First Line	:	2060 A1A HWY
Second Line	:
City	:	INDIAN HARBOUR BEACH
State	:	FL
Zip	:	32937-3596
Country	:	US
Telephone Number	:	321-890-7439
Fax Number	:

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

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	04/14/2015

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