MEDICARE: CAROL CHRISTINE GUSHWA

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	2251X0800X	Orthopedic Physical Therapist	PT11545	FL

General Provider Information

NPI Number	:	1942522396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL CHRISTINE GUSHWA

Provider Business Mailing Address
First Line	:	2373 SW 30TH TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-4368
Country	:	US
Telephone Number	:	954-587-6674
Fax Number	:

Provider Business Practice Location Address
First Line	:	2373 SW 30TH TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-4368
Country	:	US
Telephone Number	:	954-587-6674
Fax Number	:

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

Provider Enumeration Date	:	02/25/2010
Last Update Date	:	02/25/2010

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