MEDICARE: MRS. JANE J HLIS P.T.

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	PT5979	FL

General Provider Information

NPI Number	:	1316943046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANE J HLIS P.T.

Provider Business Mailing Address
First Line	:	100210 OVERSEAS HWY
Second Line	:	SUITE 2
City	:	KEY LARGO
State	:	FL
Zip	:	33037-2526
Country	:	US
Telephone Number	:	305-453-1088
Fax Number	:

Provider Business Practice Location Address
First Line	:	100210 OVERSEAS HWY
Second Line	:	SUITE 2
City	:	KEY LARGO
State	:	FL
Zip	:	33037-2526
Country	:	US
Telephone Number	:	305-453-1088
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	09/06/2007

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