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NPI Code Detail

MEDICARE: MELISSA LEBLANC PT

MEDICARE: MELISSA LEBLANC 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
1174400000XSpecialistPT 20608FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT 20608OTHERFLPHYSICAL THERAPY
2Y060KOTHERFLBCBS

General Provider Information

NPI Number : 1619912185
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA LEBLANC PT
Provider Business Mailing Address
First Line : 2215 E HENRY AVE
Second Line :
City : TAMPA
State : FL
Zip : 33610-4432
Country : US
Telephone Number : 813-239-1179
Fax Number : 813-237-3091
Provider Business Practice Location Address
First Line : 2215 E HENRY AVE
Second Line :
City : TAMPA
State : FL
Zip : 33610-4432
Country : US
Telephone Number : 813-239-1179
Fax Number : 813-237-3091
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2006
Last Update Date : 07/09/2007

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