MEDICARE: TIMOTHY P CLEARY PT

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	PT 15929	FL

General Provider Information

NPI Number	:	1649306812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY P CLEARY PT

Provider Business Mailing Address
First Line	:	4715 LUCERNE LAKES BLVD E
Second Line	:	#205
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-3999
Country	:	US
Telephone Number	:	561-632-0207
Fax Number	:

Provider Business Practice Location Address
First Line	:	4715 LUCERNE LAKES BLVD E
Second Line	:	#205
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-3999
Country	:	US
Telephone Number	:	561-632-0207
Fax Number	:

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

Provider Enumeration Date	:	02/24/2007
Last Update Date	:	03/28/2019

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