MEDICARE: RECHARGED PERFORMANCE THERAPY 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

General Provider Information

NPI Number	:	1972152270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECHARGED PERFORMANCE THERAPY LLC

Provider Business Mailing Address
First Line	:	246 SUTHERLAND DR SW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-3473
Country	:	US
Telephone Number	:	972-935-1238
Fax Number	:

Provider Business Practice Location Address
First Line	:	246 SUTHERLAND DR SW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-3473
Country	:	US
Telephone Number	:	972-935-1238
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PAIGE HUBERT
Credential	:	PT, DPT
Telephone Number	:	972-935-1238

Provider Enumeration Date	:	09/09/2019
Last Update Date	:	09/09/2019

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