MEDICARE: MEDLEY SWIM SYSTEMS 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

General Provider Information

NPI Number	:	1285676528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDLEY SWIM SYSTEMS INC

Provider Business Mailing Address
First Line	:	PO BOX 342348
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78734-0040
Country	:	US
Telephone Number	:	512-261-0620
Fax Number	:	512-261-9441

Provider Business Practice Location Address
First Line	:	1927 LOHMANS CROSSING RD
Second Line	:	SUITE 100
City	:	AUSTIN
State	:	TX
Zip	:	78734-5239
Country	:	US
Telephone Number	:	512-261-0620
Fax Number	:	512-261-9441

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. BARKER F KEITH II
Credential	:
Telephone Number	:	512-261-0620

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/03/2013

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