MEDICARE: MEDICAL & SPORTS REHABILITATION CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225200000X	Physical Therapy Assistant
2	225700000X	Massage Therapist
3	225X00000X	Occupational Therapist
4	225XH1200X	Hand Occupational Therapist
5	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT0001402	OTHER	FL	PT LICENSE NUMBER
2	PT0004535	OTHER	FL	PT LICENSE NUMBER
3	R32	OTHER	FL	BCBS PROVIDER NUMBER
4	OT6930	OTHER	FL	OT LICENSE NUMBER
5	OT9990	OTHER	FL	OT LICENSE NUMBER
6	PT21393	OTHER	FL	PT LICENSE NUMBER
7	OT8618	OTHER	FL	OT LICENSE NUMBER

General Provider Information

NPI Number	:	1558315663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL & SPORTS REHABILITATION CENTER INC

Provider Business Mailing Address
First Line	:	689 TAMIAMI TRL N
Second Line	:	STE E
City	:	NAPLES
State	:	FL
Zip	:	34102-8100
Country	:	US
Telephone Number	:	239-261-0291
Fax Number	:	239-261-0678

Provider Business Practice Location Address
First Line	:	661 GOODLETTE RD N
Second Line	:	STE 101
City	:	NAPLES
State	:	FL
Zip	:	34102-5609
Country	:	US
Telephone Number	:	239-261-4592
Fax Number	:	239-261-0716

Authorized Official
Title or Position	:	MANAGER
Name	:	BETH YURKOVAC
Credential	:
Telephone Number	:	239-261-0291

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	03/19/2008

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Directions to “MEDICAL & SPORTS REHABILITATION CENTER INC ” Practice Location

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