MEDICARE: DANA UNSELL 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	PT3526	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01 0853148	OTHER	FL	TAX ID # QIM INC.HOME PT

General Provider Information

NPI Number	:	1811062458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA UNSELL PT

Provider Business Mailing Address
First Line	:	4740 HUNTING TRL
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-3526
Country	:	US
Telephone Number	:	561-281-1403
Fax Number	:	561-433-8981

Provider Business Practice Location Address
First Line	:	4740 HUNTING TRL
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-3526
Country	:	US
Telephone Number	:	561-281-1403
Fax Number	:	561-433-8981

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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Directions to “ DANA UNSELL PT” Practice Location

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