MEDICARE: PALM BEACH AQUATICS & PHYSICAL THERAPY INC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB1527	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	Y912H	OTHER	FL	BCBS GROUP NUMBER
3	Y90RQ	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1841263464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH AQUATICS & PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	5130 LINTON BLVD
Second Line	:	SUITE H-1
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6596
Country	:	US
Telephone Number	:	561-865-2800
Fax Number	:	561-865-0097

Provider Business Practice Location Address
First Line	:	3111 W BOYNTON BEACH BLVD
Second Line	:	SUITE 200
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4613
Country	:	US
Telephone Number	:	561-742-3283
Fax Number	:	561-742-3280

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ADRI HERNANDEZ MOTE
Credential	:
Telephone Number	:	561-865-2800

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	08/28/2014

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Directions to “PALM BEACH AQUATICS & PHYSICAL THERAPY INC ” Practice Location

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