MEDICARE: NICHOLAS DENTE PTA

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	225200000X	Physical Therapy Assistant	PTA23432	FL

General Provider Information

NPI Number	:	1679825657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS DENTE PTA

Provider Business Mailing Address
First Line	:	6609 W WOOLBRIGHT RD
Second Line	:	SUITE420
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-0917
Country	:	US
Telephone Number	:	561-200-4262
Fax Number	:	561-200-4268

Provider Business Practice Location Address
First Line	:	6609 W WOOLBRIGHT RD
Second Line	:	SUITE420
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-0917
Country	:	US
Telephone Number	:	561-200-4262
Fax Number	:	561-200-4268

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

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	10/15/2012

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