MEDICARE: ANNE MARIE GYSELINCK MCMAHON PTA

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	225200000X	Physical Therapy Assistant	PTA 118	FL

General Provider Information

NPI Number	:	1366709305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE MARIE GYSELINCK MCMAHON PTA

Provider Business Mailing Address
First Line	:	5301 40TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-5609
Country	:	US
Telephone Number	:	727-366-7066
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 40TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-5609
Country	:	US
Telephone Number	:	727-366-7066
Fax Number	:

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

Provider Enumeration Date	:	04/16/2012
Last Update Date	:	04/16/2012

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