MEDICARE: JUDI SUE HAMELBURG P.T.

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	PT 0003973	FL

General Provider Information

NPI Number	:	1932277001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDI SUE HAMELBURG P.T.

Provider Business Mailing Address
First Line	:	1015 NE 116TH ST
Second Line	:
City	:	BISCAYNE PARK
State	:	FL
Zip	:	33161-6743
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1031 IVES DAIRY RD
Second Line	:	228
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33179-2538
Country	:	US
Telephone Number	:	305-770-0747
Fax Number	:

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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