MEDICARE: MR. EDWARD A LUNDGREN PT

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	PT798	FL

General Provider Information

NPI Number	:	1760490635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD A LUNDGREN PT

Provider Business Mailing Address
First Line	:	199 W PALMETTO PARK RD
Second Line	:	SUITE 7
City	:	BOCA RATON
State	:	FL
Zip	:	33432-3809
Country	:	US
Telephone Number	:	561-338-8851
Fax Number	:	561-391-0490

Provider Business Practice Location Address
First Line	:	199 W PALMETTO PARK RD
Second Line	:	SUITE 7
City	:	BOCA RATON
State	:	FL
Zip	:	33432-3809
Country	:	US
Telephone Number	:	561-338-8851
Fax Number	:	561-391-0490

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	05/15/2008

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