MEDICARE: MR. ERIC M WELLING MPT

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	PT 23406	FL

General Provider Information

NPI Number	:	1528000312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC M WELLING MPT

Provider Business Mailing Address
First Line	:	PO BOX 8600
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34985-8600
Country	:	US
Telephone Number	:	772-335-7966
Fax Number	:	772-335-7963

Provider Business Practice Location Address
First Line	:	160 NW CENTRAL PARK PLZ
Second Line	:	SUITE 108
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-1825
Country	:	US
Telephone Number	:	772-621-9313
Fax Number	:	772-621-9358

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	08/27/2007

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