MEDICARE: BODY ARMOR SPORTS AND ORTHOPEDIC 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	261QP2000X	Physical Therapy Clinic/Center	PT 31487	FL

General Provider Information

NPI Number	:	1558811851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY ARMOR SPORTS AND ORTHOPEDIC PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	7928 EAST DR APT 2001
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-5685
Country	:	US
Telephone Number	:	310-405-1945
Fax Number	:

Provider Business Practice Location Address
First Line	:	7928 EAST DR APT 2001
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-5685
Country	:	US
Telephone Number	:	310-405-1945
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY, OWNER
Name	:	JORDAN GUY CLAYBORNE
Credential	:	PT
Telephone Number	:	310-405-1945

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	10/11/2016

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