MEDICARE: SHERMAN REGAL MERCADO RPT

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	PT14953	FL

General Provider Information

NPI Number	:	1619184751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERMAN REGAL MERCADO RPT

Provider Business Mailing Address
First Line	:	1289 NE 105TH ST
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1289 NE 105TH ST
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2105
Country	:	US
Telephone Number	:	305-979-6407
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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Directions to “ SHERMAN REGAL MERCADO RPT” Practice Location

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