MEDICARE: LEE COUNTY PHYSICAL MEDICINE LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies	ME100125	FL
2	111N00000X	Chiropractor
3	207R00000X	Internal Medicine Physician	ME100125	FL

General Provider Information

NPI Number	:	1659716975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE COUNTY PHYSICAL MEDICINE LLC

Provider Business Mailing Address
First Line	:	6150 DIAMOND CENTRE CT
Second Line	:	SUITE 1003
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4368
Country	:	US
Telephone Number	:	239-245-7909
Fax Number	:	239-245-7981

Provider Business Practice Location Address
First Line	:	6150 DIAMOND CENTRE CT
Second Line	:	SUITE 1003
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4368
Country	:	US
Telephone Number	:	239-245-7909
Fax Number	:	239-245-7981

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL A LAMPE
Credential	:
Telephone Number	:	239-245-7909

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	05/07/2014

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