MEDICARE: HOME SWEET HOME PHYSICAL THERAPY

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

General Provider Information

NPI Number	:	1841544715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME SWEET HOME PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	109 BELLINI CT
Second Line	:
City	:	NORTH VENICE
State	:	FL
Zip	:	34275-6689
Country	:	US
Telephone Number	:	941-228-9072
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 BELLINI CT
Second Line	:
City	:	NORTH VENICE
State	:	FL
Zip	:	34275-6689
Country	:	US
Telephone Number	:	941-228-9072
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ADAM PEACOCK
Credential	:
Telephone Number	:	941-228-9072

Provider Enumeration Date	:	10/31/2012
Last Update Date	:	10/31/2012

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