MEDICARE: MISS GAITRI PERSAUD PTA

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	251K00000X	Public Health or Welfare Agency	PTA20424	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTA20424	OTHER	FL	PHYSICAL THERAPY ASSISTAN

General Provider Information

NPI Number	:	1558570663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GAITRI PERSAUD PTA

Provider Business Mailing Address
First Line	:	403 NW 68TH AVE
Second Line	:	#505
City	:	PLANTATION
State	:	FL
Zip	:	33317-7585
Country	:	US
Telephone Number	:	954-918-5344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1191 E NEWPORT CENTER DR
Second Line	:	PENT HOUSE J
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-7715
Country	:	US
Telephone Number	:	954-379-1066
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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