MEDICARE: MRS. MARY JANE BIANCO MSPT

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	20812	FL
2	225100000X	Physical Therapist	40QA00593500	NJ

General Provider Information

NPI Number	:	1427025246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY JANE BIANCO MSPT

Provider Business Mailing Address
First Line	:	13654 JONQUIL PL
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-8558
Country	:	US
Telephone Number	:	561-784-2434
Fax Number	:

Provider Business Practice Location Address
First Line	:	2670 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5972
Country	:	US
Telephone Number	:	561-968-9100
Fax Number	:	561-968-9233

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	07/08/2007

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