MEDICARE: ATLANTIC SPORTCARE 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	PT5979	FL

General Provider Information

NPI Number	:	1538186192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC SPORTCARE INC

Provider Business Mailing Address
First Line	:	106 NAUTILUS DR
Second Line	:
City	:	ISLAMORADA
State	:	FL
Zip	:	33036-4207
Country	:	US
Telephone Number	:	305-395-0463
Fax Number	:

Provider Business Practice Location Address
First Line	:	100210 OVERSEAS HWY
Second Line	:	SUITE 2
City	:	KEY LARGO
State	:	FL
Zip	:	33037-2526
Country	:	US
Telephone Number	:	305-453-1152
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JANE J HLIS
Credential	:	PT
Telephone Number	:	305-395-0463

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	11/29/2010

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Directions to “ATLANTIC SPORTCARE INC ” Practice Location

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