MEDICARE: CREST PHYSICAL THERAPY , INC.

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	174400000X	Specialist

General Provider Information

NPI Number	:	1730534371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREST PHYSICAL THERAPY , INC.

Provider Business Mailing Address
First Line	:	3754 SW 56TH RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-5132
Country	:	US
Telephone Number	:	352-219-6769
Fax Number	:

Provider Business Practice Location Address
First Line	:	3754 SW 56TH RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-5132
Country	:	US
Telephone Number	:	352-219-6769
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. AKINSOLA MIKAIL AKINYODE
Credential	:	PT
Telephone Number	:	352-219-6769

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	05/02/2016

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