Basic Information
| Provider Information | |||||||||
| NPI: | 1871603910 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MCDOWELL | ||||||||
| FirstName: | FOREST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 E EAU GALLIE BLVD STE 106 | ||||||||
| Address2: | |||||||||
| City: | INDIAN HARBOUR BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329374252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516969353 | ||||||||
| FaxNumber: | 9519737216 | ||||||||
| Practice Location | |||||||||
| Address1: | 4270 MINTON RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | WEST MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329049579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516969353 | ||||||||
| FaxNumber: | 9519737216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1871603910 | 01 | FL | NPI | OTHER | K3234 | 01 | FL | MEDICARE | OTHER | PT2813 | 01 | FL | LICENSE | OTHER |