MEDICARE: PHYSICAL THERAPY AND WELLNESS CENTER

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	PT15250	FL

General Provider Information

NPI Number	:	1619006962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	183 MADEIRA AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4515
Country	:	US
Telephone Number	:	305-444-8775
Fax Number	:	305-444-8774

Provider Business Practice Location Address
First Line	:	183 MADEIRA AVE
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4515
Country	:	US
Telephone Number	:	305-444-8775
Fax Number	:	305-444-8774

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS ANNA K TISCHENKO
Credential	:	PT
Telephone Number	:	305-444-8775

Provider Enumeration Date	:	03/04/2007
Last Update Date	:	08/22/2020

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