MEDICARE: LORELIE FLEETWOOD

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

General Provider Information

NPI Number	:	1588845291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORELIE FLEETWOOD

Provider Business Mailing Address
First Line	:	13999 E CARTER RD
Second Line	:
City	:	BLOOMFIELD
State	:	IN
Zip	:	47424-6125
Country	:	US
Telephone Number	:	812-350-8315
Fax Number	:

Provider Business Practice Location Address
First Line	:	2346 MEADOW BEND DR
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-1426
Country	:	US
Telephone Number	:	812-350-8315
Fax Number	:

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

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	01/09/2019

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Directions to “ LORELIE FLEETWOOD ” Practice Location

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