MEDICARE: ANATOMIC HEALTH LLC

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1720234677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANATOMIC HEALTH LLC

Provider Business Mailing Address
First Line	:	6750 N ANDREWS AVE
Second Line	:	SUITE 200, #2125
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-2173
Country	:	US
Telephone Number	:	954-489-1121
Fax Number	:	954-772-7801

Provider Business Practice Location Address
First Line	:	6750 N ANDREWS AVE
Second Line	:	SUITE 200, #2125
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-2173
Country	:	US
Telephone Number	:	954-489-1121
Fax Number	:	954-772-7801

Authorized Official
Title or Position	:	PRESIDENT/MANAGING MEMBER
Name	:	MR. JOHN TOBIAS GRAY
Credential	:	PA-C
Telephone Number	:	954-292-8657

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	09/21/2012

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