MEDICARE: VIP 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		FL

General Provider Information

NPI Number	:	1437339819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIP PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	1484 E TERRA MAR DR
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-6839
Country	:	US
Telephone Number	:	954-529-6236
Fax Number	:	954-946-9630

Provider Business Practice Location Address
First Line	:	1484 E TERRA MAR DR
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-6839
Country	:	US
Telephone Number	:	954-529-6236
Fax Number	:	954-946-9630

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK LEAGER
Credential	:
Telephone Number	:	954-529-6236

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	11/14/2007

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