MEDICARE: MR. ROBERT JAMES CORRIS II 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	PT8071	FL

General Provider Information

NPI Number	:	1780703074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT JAMES CORRIS II PT

Provider Business Mailing Address
First Line	:	4705 ALT 19
Second Line	:	SUITE A
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1440
Country	:	US
Telephone Number	:	727-781-3550
Fax Number	:	727-781-3450

Provider Business Practice Location Address
First Line	:	4705 ALT 19
Second Line	:	SUITE A
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-1440
Country	:	US
Telephone Number	:	727-781-3550
Fax Number	:	727-781-3450

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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