MEDICARE: HIGH ENERGY PHYSIOTRAINING, CORP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2251X0800X	Orthopedic Physical Therapist
2	225700000X	Massage Therapist
3	2251G0304X	Geriatric Physical Therapist
4	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1588814511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH ENERGY PHYSIOTRAINING, CORP

Provider Business Mailing Address
First Line	:	3100 COUNTRY CLUB LN
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-5126
Country	:	US
Telephone Number	:	754-581-1605
Fax Number	:	954-455-1701

Provider Business Practice Location Address
First Line	:	3100 COUNTRY CLUB LN
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-5126
Country	:	US
Telephone Number	:	754-581-1605
Fax Number	:	954-455-1701

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CRISTIANE BARBOSA TIMOTEO
Credential	:	PTA, CWT
Telephone Number	:	754-581-1605

Provider Enumeration Date	:	09/26/2008
Last Update Date	:	12/26/2008

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