MEDICARE: PALMETTO PHYSICAL THERAPY

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

General Provider Information

NPI Number	:	1548249253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	2104 W 68TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1804
Country	:	US
Telephone Number	:	305-823-7199
Fax Number	:	305-823-4566

Provider Business Practice Location Address
First Line	:	2104 W 68TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-1804
Country	:	US
Telephone Number	:	305-823-7199
Fax Number	:	305-823-4566

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OSMANY OTERO
Credential	:
Telephone Number	:	305-823-7199

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	08/22/2020

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Directions to “PALMETTO PHYSICAL THERAPY ” Practice Location

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