MEDICARE: WESTCHASE PHYSICAL THERAPY AND MEDICAL SUPPLY LLC

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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1396504734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTCHASE PHYSICAL THERAPY AND MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	12705 RACE TRACK RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1314
Country	:	US
Telephone Number	:	813-343-3960
Fax Number	:	818-343-3965

Provider Business Practice Location Address
First Line	:	3953 TAMPA RD STE 102
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-3233
Country	:	US
Telephone Number	:	813-343-3960
Fax Number	:	813-343-3965

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN MAGEE
Credential	:	DPT
Telephone Number	:	813-343-3960

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	03/18/2024

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