MEDICARE: HOMER BUSI PIQUE

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	225200000X	Physical Therapy Assistant	2128459	TX

General Provider Information

NPI Number	:	1477083160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOMER BUSI PIQUE

Provider Business Mailing Address
First Line	:	12272 W SAMPLE RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4227
Country	:	US
Telephone Number	:	571-215-6850
Fax Number	:

Provider Business Practice Location Address
First Line	:	12272 WEST SAMPLE ROAD
Second Line	:
City	:	CORAL SPRING
State	:	FL
Zip	:	33065
Country	:	US
Telephone Number	:	571-215-6850
Fax Number	:

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

Provider Enumeration Date	:	06/14/2017
Last Update Date	:	07/21/2022

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Directions to “ HOMER BUSI PIQUE ” Practice Location

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