MEDICARE: KEY BISCAYNE PHYSICAL THERAPY L.L.C.

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
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1700153988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEY BISCAYNE PHYSICAL THERAPY L.L.C.

Provider Business Mailing Address
First Line	:	PO BOX 331931
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33233
Country	:	US
Telephone Number	:	305-722-0568
Fax Number	:	305-670-0899

Provider Business Practice Location Address
First Line	:	240 CRANDON BLVD
Second Line	:	SUITE 202
City	:	KEY BISCAYNE
State	:	FL
Zip	:	33149-1543
Country	:	US
Telephone Number	:	305-722-0568
Fax Number	:	305-722-0569

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RONALD R YACOUB
Credential	:	MSPT
Telephone Number	:	305-302-1828

Provider Enumeration Date	:	11/16/2011
Last Update Date	:	07/25/2022

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