MEDICARE: REQUEST PHYSICAL THERAPY 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	PT20347	FL

General Provider Information

NPI Number	:	1356440523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REQUEST PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	2722 MANATEE AVE W
Second Line	:	SUITE 2
City	:	BRADENTON
State	:	FL
Zip	:	34205-4945
Country	:	US
Telephone Number	:	941-744-9046
Fax Number	:

Provider Business Practice Location Address
First Line	:	2722 MANATEE AVE W
Second Line	:	SUITE 2
City	:	BRADENTON
State	:	FL
Zip	:	34205-4945
Country	:	US
Telephone Number	:	941-744-9046
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN WALZ
Credential	:	MPT
Telephone Number	:	941-744-9046

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	01/12/2009

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