MEDICARE: LORI LEBARNES PT

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	174400000X	Specialist	PT21058	FL

General Provider Information

NPI Number	:	1619033461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI LEBARNES PT

Provider Business Mailing Address
First Line	:	12402 MAIDSTONE CT
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-2866
Country	:	US
Telephone Number	:	813-343-5500
Fax Number	:	813-343-5506

Provider Business Practice Location Address
First Line	:	12625 RACE TRACK RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1331
Country	:	US
Telephone Number	:	813-343-5500
Fax Number	:	813-343-5506

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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Directions to “ LORI LEBARNES PT” Practice Location

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