MEDICARE: SMART BODY 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

General Provider Information

NPI Number	:	1396767018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMART BODY PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	6639 SOUTHPOINT PARKWAY
Second Line	:	STE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216
Country	:	US
Telephone Number	:	904-296-4140
Fax Number	:	904-279-0963

Provider Business Practice Location Address
First Line	:	6639 SOUTHPOINT PARKWAY
Second Line	:	STE 103
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216
Country	:	US
Telephone Number	:	904-296-4140
Fax Number	:	904-279-0963

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. LAURA BUNSO BITTENCOURT
Credential	:	PT
Telephone Number	:	904-296-4140

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/29/2014

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