MEDICARE: FRANK JOSEPH DIMAGGIO 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	PT0002323	FL

General Provider Information

NPI Number	:	1659629715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK JOSEPH DIMAGGIO PT

Provider Business Mailing Address
First Line	:	2631 E OAKLAND PARK BLVD
Second Line	:	SUITE 104
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1657
Country	:	US
Telephone Number	:	954-537-5558
Fax Number	:	954-537-7997

Provider Business Practice Location Address
First Line	:	2631 E OAKLAND PARK BLVD
Second Line	:	SUITE 104
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1657
Country	:	US
Telephone Number	:	954-537-5558
Fax Number	:	954-537-7997

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

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	08/21/2012

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