MEDICARE: PRO FITNESS PHYSICAL THERAPY, CORP

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1700104395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO FITNESS PHYSICAL THERAPY, CORP

Provider Business Mailing Address
First Line	:	6900 BAY DR APT 9G
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-5464
Country	:	US
Telephone Number	:	786-704-6701
Fax Number	:	305-428-2698

Provider Business Practice Location Address
First Line	:	6900 BAY DR APT 9G
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-5464
Country	:	US
Telephone Number	:	786-704-6701
Fax Number	:	305-428-2698

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PEDRO GONZALEZ
Credential	:
Telephone Number	:	786-704-6701

Provider Enumeration Date	:	05/07/2010
Last Update Date	:	05/07/2010

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