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NPI Code Detail

MEDICARE: LEAH A METELNIKOW MSPT

MEDICARE:   LEAH A METELNIKOW  MSPT
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
1225100000XPhysical TherapistPT0013742FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
113425001OTHERFLCITRUS CAID HMO

General Provider Information

NPI Number : 1588770903
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH A METELNIKOW MSPT
Provider Business Mailing Address
First Line : 1215 E ORANGE ST
Second Line :
City : LAKELAND
State : FL
Zip : 33801-5762
Country : US
Telephone Number : 863-802-3800
Fax Number :
Provider Business Practice Location Address
First Line : 1215 E ORANGE ST
Second Line :
City : LAKELAND
State : FL
Zip : 33801-5762
Country : US
Telephone Number : 863-802-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/09/2007

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Directions to “ LEAH A METELNIKOW MSPT” Practice Location

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