MEDICARE: MARCIA NATHAN

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	261QR0400X	Rehabilitation Clinic/Center	MA72562	FL

General Provider Information

NPI Number	:	1588074058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCIA NATHAN

Provider Business Mailing Address
First Line	:	1084 LEE RD
Second Line	:	SUITE 7
City	:	ORLANDO
State	:	FL
Zip	:	32810-5821
Country	:	US
Telephone Number	:	407-953-8714
Fax Number	:	407-293-8891

Provider Business Practice Location Address
First Line	:	1084 LEE RD
Second Line	:	SUITE 7
City	:	ORLANDO
State	:	FL
Zip	:	32810-5821
Country	:	US
Telephone Number	:	407-953-8714
Fax Number	:	407-293-8891

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARCIA A NATHAN
Credential	:	LMT
Telephone Number	:	407-953-8714

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	05/05/2014

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