MEDICARE: SELECT PHYSICAL THERAPY

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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT11588	OTHER	FL	OTR

General Provider Information

NPI Number	:	1376681130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELECT PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	5603 SKIMMER DR
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-3353
Country	:	US
Telephone Number	:	813-645-8789
Fax Number	:

Provider Business Practice Location Address
First Line	:	5603 SKIMMER DR
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-3353
Country	:	US
Telephone Number	:	813-645-8789
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THEAPIST
Name	:	MRS. CLAUDIA ANN HOOD
Credential	:	OTR
Telephone Number	:	813-654-1410

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	06/01/2008

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