Individual
EDWARD JOHN MCCORMACK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
7200 W CAMINO REAL, SUITE 101, BOCA RATON, FL 33433-5511
(561) 789-2046
Mailing address
2170 SW 7TH CT, BOCA RATON, FL 33486-6951
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 4994
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT04994
PHYSICAL THERAPY LICENSE
FL
Enumeration date
09/02/2006
Last updated
03/19/2008
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