MEDICARE: MARY AGNES MURALLON 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	225100000X	Physical Therapist	PT6747	FL

General Provider Information

NPI Number	:	1033460977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY AGNES MURALLON PT

Provider Business Mailing Address
First Line	:	2222 SULLIVAN TRL
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18040-7958
Country	:	US
Telephone Number	:	800-944-9782
Fax Number	:	610-438-2046

Provider Business Practice Location Address
First Line	:	203 S WEKIWA SPRINGS RD
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-4778
Country	:	US
Telephone Number	:	407-814-1700
Fax Number	:	407-814-1700

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

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	10/01/2012

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