MEDICARE: MR. KAHARI TAMON WOOD MSPT

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	PT21707	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952333502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KAHARI TAMON WOOD MSPT

Provider Business Mailing Address
First Line	:	2531 SW FONDURA RD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-2773
Country	:	US
Telephone Number	:	772-348-4272
Fax Number	:	772-348-4612

Provider Business Practice Location Address
First Line	:	2531 SW FONDURA RD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-2773
Country	:	US
Telephone Number	:	772-348-4272
Fax Number	:	772-348-4612

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/09/2020

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