MEDICARE: DR. CHARLES MICHAEL SHAPIRO PT

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	PT0002021	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT0002021	OTHER	FL	FL PT LICENSE

General Provider Information

NPI Number	:	1508998436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES MICHAEL SHAPIRO PT

Provider Business Mailing Address
First Line	:	3850 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3634
Country	:	US
Telephone Number	:	954-989-5255
Fax Number	:	954-962-6445

Provider Business Practice Location Address
First Line	:	3850 SHERIDAN ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3634
Country	:	US
Telephone Number	:	954-989-5255
Fax Number	:	954-962-6445

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	08/30/2012

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