MEDICARE: MR. CHARLES SIZEMORE DPT

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	1243323	TX

General Provider Information

NPI Number	:	1316350283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES SIZEMORE DPT

Provider Business Mailing Address
First Line	:	1010 N BELT LINE RD
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-1781
Country	:	US
Telephone Number	:	972-288-2400
Fax Number	:	972-288-0222

Provider Business Practice Location Address
First Line	:	1010 N BELT LINE RD
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-1781
Country	:	US
Telephone Number	:	972-288-2400
Fax Number	:	972-288-0222

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

Provider Enumeration Date	:	06/08/2014
Last Update Date	:	06/08/2014

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