MEDICARE: CLOVERLEAF SERVICES, 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1447870753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOVERLEAF SERVICES, INC

Provider Business Mailing Address
First Line	:	9501 ANCHUSA TRL
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-2335
Country	:	US
Telephone Number	:	512-461-1902
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 ANCHUSA TRL
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-2335
Country	:	US
Telephone Number	:	512-461-1902
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	RAFAEL PARDEIRO
Credential	:	MSPT
Telephone Number	:	512-461-1902

Provider Enumeration Date	:	04/16/2020
Last Update Date	:	04/22/2020

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