MEDICARE: MRS. ELISE SARA BATTILLO 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	PT7397	FL

General Provider Information

NPI Number	:	1487891677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELISE SARA BATTILLO P.T.

Provider Business Mailing Address
First Line	:	1184 CYPRESS LOFT PL
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-4449
Country	:	US
Telephone Number	:	407-804-9803
Fax Number	:	407-574-5544

Provider Business Practice Location Address
First Line	:	1184 CYPRESS LOFT PL
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-4449
Country	:	US
Telephone Number	:	407-804-9803
Fax Number	:	407-574-5544

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

Provider Enumeration Date	:	01/10/2009
Last Update Date	:	01/10/2009

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