MEDICARE: ALL COAST THERAPY SERVICES OUTPATIENT INC

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	RS4	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1275822983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL COAST THERAPY SERVICES OUTPATIENT INC

Provider Business Mailing Address
First Line	:	PO BOX 490210
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34749-0210
Country	:	US
Telephone Number	:	352-326-4014
Fax Number	:	352-326-4126

Provider Business Practice Location Address
First Line	:	704 DOCTORS CT
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-7366
Country	:	US
Telephone Number	:	352-365-1267
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL HORSLEY
Credential	:	PT
Telephone Number	:	352-326-4014

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	04/04/2011

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