MEDICARE: MRS. IVORY TEODORO FOX 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	PT33437	FL
2	222Q00000X	Developmental Therapist
3	225100000X	Physical Therapist	05003234A	IN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477632719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. IVORY TEODORO FOX P.T.

Provider Business Mailing Address
First Line	:	12220 TOWNE LAKE DR STE 1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-8021
Country	:	US
Telephone Number	:	239-433-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	12220 TOWNE LAKE DR STE 1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-8021
Country	:	US
Telephone Number	:	239-433-6700
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	09/09/2025

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Directions to “ MRS. IVORY TEODORO FOX P.T.” Practice Location

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