MEDICARE: MR. MICHAEL JOSEPH HAINES 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	225100000X	Physical Therapist	PTA21271	FL

General Provider Information

NPI Number	:	1386808863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JOSEPH HAINES PTA

Provider Business Mailing Address
First Line	:	150 WEYBRIDGE CIR APT A
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1537
Country	:	US
Telephone Number	:	561-252-5418
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 WEYBRIDGE CIR APT A
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1537
Country	:	US
Telephone Number	:	561-252-5418
Fax Number	:

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

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	07/15/2008

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