MEDICARE: MR. MARLON ALAAN P.T.

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	PT 9224	FL

General Provider Information

NPI Number	:	1407191646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARLON ALAAN P.T.

Provider Business Mailing Address
First Line	:	9223 JAKES PATH
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-6314
Country	:	US
Telephone Number	:	727-581-7273
Fax Number	:

Provider Business Practice Location Address
First Line	:	3865 TAMPA RD
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-3008
Country	:	US
Telephone Number	:	813-855-4661
Fax Number	:

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

Provider Enumeration Date	:	11/28/2012
Last Update Date	:	11/28/2012

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