MEDICARE: COMPREHENSIVE PHYSICAL THERAPY CARE

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	208100000X	Physical Medicine & Rehabilitation Physician	PT0010746	FL

General Provider Information

NPI Number	:	1538123682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE PHYSICAL THERAPY CARE

Provider Business Mailing Address
First Line	:	4517 PEBBLE BEACH DR
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-1731
Country	:	US
Telephone Number	:	863-453-3701
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 W STRATFORD RD
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-8091
Country	:	US
Telephone Number	:	863-453-3701
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROWENA BADENHORST
Credential	:	P.T.
Telephone Number	:	863-453-3701

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/21/2008

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