MEDICARE: KATHERINE CANCINO SCHOLL MSPT

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	23914	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588822126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE CANCINO SCHOLL MSPT

Provider Business Mailing Address
First Line	:	1400 SE GOLDTREE DR STE 205
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7583
Country	:	US
Telephone Number	:	772-335-7966
Fax Number	:	772-335-7963

Provider Business Practice Location Address
First Line	:	2150 S DIXIE HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-2462
Country	:	US
Telephone Number	:	305-860-6383
Fax Number	:	305-860-6526

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	01/27/2022

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