MEDICARE: MISS DORA ESTELA SARLI P.T.

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	PT14581	FL

General Provider Information

NPI Number	:	1841508033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DORA ESTELA SARLI P.T.

Provider Business Mailing Address
First Line	:	3200 N A1A
Second Line	:	UNIT 1203
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-8872
Country	:	US
Telephone Number	:	772-240-4765
Fax Number	:	772-468-1075

Provider Business Practice Location Address
First Line	:	3200 N A1A
Second Line	:	UNIT 1203
City	:	FORT PIERCE
State	:	FL
Zip	:	34949-8872
Country	:	US
Telephone Number	:	772-240-4765
Fax Number	:	772-468-1075

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

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	09/22/2010

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