MEDICARE: MAGEE HEALTHCARE 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	261QP2000X	Physical Therapy Clinic/Center	PT21841	FL

General Provider Information

NPI Number	:	1760806517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGEE HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	12625 RACE TRACK RD
Second Line	:	WESTCHASE
City	:	TAMPA
State	:	FL
Zip	:	33626-1331
Country	:	US
Telephone Number	:	813-343-3960
Fax Number	:	813-343-3965

Provider Business Practice Location Address
First Line	:	12625 RACE TRACK RD
Second Line	:	WESTCHASE
City	:	TAMPA
State	:	FL
Zip	:	33626-1331
Country	:	US
Telephone Number	:	813-343-3960
Fax Number	:	813-343-3965

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN PATRICK MAGEE
Credential	:
Telephone Number	:	813-343-3960

Provider Enumeration Date	:	02/14/2014
Last Update Date	:	05/11/2016

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