MEDICARE: MR. PAUL B LONNEMANN PT OCS MTC

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	05005100A	IN

General Provider Information

NPI Number	:	1639169311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL B LONNEMANN PT OCS MTC

Provider Business Mailing Address
First Line	:	756 HIGHLANDER POINT DR
Second Line	:
City	:	FLOYDS KNOBS
State	:	IN
Zip	:	47119-9682
Country	:	US
Telephone Number	:	812-923-0630
Fax Number	:	812-923-0632

Provider Business Practice Location Address
First Line	:	756 HIGHLANDER POINT DR
Second Line	:
City	:	FLOYDS KNOBS
State	:	IN
Zip	:	47119-9682
Country	:	US
Telephone Number	:	812-923-0630
Fax Number	:	812-923-0632

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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