MEDICARE: PHYSICAL THERAPY CONNECTION LLC

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	PT18972	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	:	1518211267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY CONNECTION LLC

Provider Business Mailing Address
First Line	:	177 HUNTINGTON AVE
Second Line	:	STE 1703 PMB 82414
City	:	BOSTON
State	:	MA
Zip	:	02115-0594
Country	:	US
Telephone Number	:	857-220-8415
Fax Number	:	772-879-6650

Provider Business Practice Location Address
First Line	:	8414 S FEDERAL HWY
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-3306
Country	:	US
Telephone Number	:	857-990-6111
Fax Number	:	833-615-1065

Authorized Official
Title or Position	:	CHIEF OF STAFF
Name	:	MAYA BEIN-NACHAL
Credential	:
Telephone Number	:	857-990-6111

Provider Enumeration Date	:	11/02/2012
Last Update Date	:	08/18/2022

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