MEDICARE: LEGACY HEALTHCARE 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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2989794	OTHER	FL	AETNA GROUP PROV NUMBER
2	RZ5	OTHER	FL	BCBS FACILITY ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306883962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGACY HEALTHCARE INC

Provider Business Mailing Address
First Line	:	8175 US HIGHWAY 301 N
Second Line	:
City	:	PARRISH
State	:	FL
Zip	:	34219-8669
Country	:	US
Telephone Number	:	941-729-0003
Fax Number	:	941-729-0004

Provider Business Practice Location Address
First Line	:	3030 UNIVERSITY PKWY
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34243-2502
Country	:	US
Telephone Number	:	941-359-8233
Fax Number	:	941-359-8255

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. CESAR CHACON
Credential	:
Telephone Number	:	941-302-9400

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	06/02/2010

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Directions to “LEGACY HEALTHCARE INC ” Practice Location

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