MEDICARE: MRS. CAROL LYNN BERCAW 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	PT4758	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821196635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL LYNN BERCAW PT

Provider Business Mailing Address
First Line	:	4561 CARTHAGE CIR N
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7205
Country	:	US
Telephone Number	:	561-683-9991
Fax Number	:	561-683-4472

Provider Business Practice Location Address
First Line	:	2250 PALM BEACH LAKES BLVD
Second Line	:	SUITE # 109
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3407
Country	:	US
Telephone Number	:	561-683-9991
Fax Number	:	561-683-4472

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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