MEDICARE: LINDSEY FUENTES

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	225200000X	Physical Therapy Assistant	PTA25900	FL

General Provider Information

NPI Number	:	1528437381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY FUENTES

Provider Business Mailing Address
First Line	:	714 BAYWOOD DR
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32773-6210
Country	:	US
Telephone Number	:	407-710-3461
Fax Number	:

Provider Business Practice Location Address
First Line	:	11543 LAKE UNDERHILL RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-5001
Country	:	US
Telephone Number	:	407-380-0357
Fax Number	:

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

Provider Enumeration Date	:	09/22/2015
Last Update Date	:	09/22/2015

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Directions to “ LINDSEY FUENTES ” Practice Location

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