MEDICARE: MRS. SARA ELLEN COVE DPT

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	21961	FL

General Provider Information

NPI Number	:	1851441422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA ELLEN COVE DPT

Provider Business Mailing Address
First Line	:	17046 BOCA CLUB BLVD APT 2
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-1083
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5155 W ATLANTIC AVE
Second Line	:	SUITE C
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8170
Country	:	US
Telephone Number	:	561-637-7195
Fax Number	:	561-638-2791

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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