MEDICARE: MRS. ANA MARIA FRAGA P.T.

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	0001974	FL

General Provider Information

NPI Number	:	1659495208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANA MARIA FRAGA P.T.

Provider Business Mailing Address
First Line	:	11343 SW 69TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-1905
Country	:	US
Telephone Number	:	305-270-1456
Fax Number	:

Provider Business Practice Location Address
First Line	:	3117 SW 13TH CT
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-2714
Country	:	US
Telephone Number	:	954-584-7178
Fax Number	:

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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