MEDICARE: TIMOTHY GEORGE FORSYTH

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 21245	FL
2	225100000X	Physical Therapist	5501011435	MI

General Provider Information

NPI Number	:	1558409391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY GEORGE FORSYTH

Provider Business Mailing Address
First Line	:	8334 CARDINAL COVE CIR
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-6335
Country	:	US
Telephone Number	:	407-489-8907
Fax Number	:

Provider Business Practice Location Address
First Line	:	1119 SAXON BLVD
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8470
Country	:	US
Telephone Number	:	389-774-4404
Fax Number	:	386-774-4496

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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Directions to “ TIMOTHY GEORGE FORSYTH ” Practice Location

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