MEDICARE: PHYSICAL THERAPY SPECIALISTS OF HUNTERS CREEK, LLC

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	261QP2000X	Physical Therapy Clinic/Center	PT20492	FL

General Provider Information

NPI Number	:	1851726012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY SPECIALISTS OF HUNTERS CREEK, LLC

Provider Business Mailing Address
First Line	:	14115 TOWN LOOP BLVD
Second Line	:	SUITE 200
City	:	ORLANDO
State	:	FL
Zip	:	32837-4839
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14115 TOWN LOOP BLVD
Second Line	:	SUITE 200
City	:	ORLANDO
State	:	FL
Zip	:	32837-4839
Country	:	US
Telephone Number	:	407-601-3922
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGING MEMBER
Name	:	DAVID KRAWCZYK
Credential	:
Telephone Number	:	407-601-3922

Provider Enumeration Date	:	09/06/2013
Last Update Date	:	12/04/2013

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