MEDICARE: SOUTH PALM PHYSICAL THERAPY SERVICES 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	PT5811	FL

General Provider Information

NPI Number	:	1629071212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH PALM PHYSICAL THERAPY SERVICES INC

Provider Business Mailing Address
First Line	:	6642 NW 25TH CT
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2016
Country	:	US
Telephone Number	:	561-376-8935
Fax Number	:	561-241-7763

Provider Business Practice Location Address
First Line	:	6642 NW 25TH CT
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2016
Country	:	US
Telephone Number	:	561-376-8935
Fax Number	:	561-241-7763

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHAEL P BOVARNICK
Credential	:	PT
Telephone Number	:	561-376-8935

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/16/2011

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