MEDICARE: CL PHYSICAL THERAPY, INC.

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	0006114	FL

General Provider Information

NPI Number	:	1588878094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CL PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	6413 JACK WRIGHT ISLAND RD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-1910
Country	:	US
Telephone Number	:	904-607-9991
Fax Number	:

Provider Business Practice Location Address
First Line	:	6413 JACK WRIGHT ISLAND RD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-1910
Country	:	US
Telephone Number	:	904-607-9991
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MS. CYNTHIA LYONS
Credential	:	PT
Telephone Number	:	904-607-9991

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	04/26/2017

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