MEDICARE: ADVANCED BODY MEDICINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician	FL
2	171100000X	Acupuncturist	FL
3	225700000X	Massage Therapist	FL
4	111N00000X	Chiropractor	FL

General Provider Information

NPI Number	:	1518173293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED BODY MEDICINE LLC

Provider Business Mailing Address
First Line	:	12701 S JOHN YOUNG PKWY
Second Line	:	SUITE 107
City	:	ORLANDO
State	:	FL
Zip	:	32837-3420
Country	:	US
Telephone Number	:	407-856-0076
Fax Number	:	407-856-0751

Provider Business Practice Location Address
First Line	:	12701 S JOHN YOUNG PKWY
Second Line	:	SUITE 107
City	:	ORLANDO
State	:	FL
Zip	:	32837-3420
Country	:	US
Telephone Number	:	407-856-0076
Fax Number	:	407-856-0751

Authorized Official
Title or Position	:	CEO
Name	:	MR. OSWALDO PEREZ
Credential	:
Telephone Number	:	407-856-0076

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	10/20/2008

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Directions to “ADVANCED BODY MEDICINE LLC ” Practice Location

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