MEDICARE: PT RPT 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	PT6667	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518055722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PT RPT INC

Provider Business Mailing Address
First Line	:	1931 SABAL PALM DR
Second Line	:	APT 103
City	:	DAVIE
State	:	FL
Zip	:	33324
Country	:	US
Telephone Number	:	954-370-9700
Fax Number	:	954-370-9700

Provider Business Practice Location Address
First Line	:	1931 SABAL PALM DR
Second Line	:	APT. 103
City	:	DAVIE
State	:	FL
Zip	:	33324-5960
Country	:	US
Telephone Number	:	954-610-5620
Fax Number	:	954-370-9700

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. PHYLLIS E TANZER
Credential	:	RPT
Telephone Number	:	954-370-9700

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/22/2020

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Directions to “PT RPT INC ” Practice Location

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