MEDICARE: DR. ANDREW DOUGLAS MISH D.P.T.

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	18566	MA
2	225100000X	Physical Therapist	PT 24940	FL

General Provider Information

NPI Number	:	1750615290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW DOUGLAS MISH D.P.T.

Provider Business Mailing Address
First Line	:	10626 LUCAYA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 ARGERIAN DR STE 102
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33545-4145
Country	:	US
Telephone Number	:	813-907-0548
Fax Number	:

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

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	10/01/2009

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