MEDICARE: CLARKE AVELLANOSA

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	PT30702	FL

General Provider Information

NPI Number	:	1043168354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARKE AVELLANOSA

Provider Business Mailing Address
First Line	:	5215 N CARNATION DR
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-2942
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5215 N CARNATION DR
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-2942
Country	:	US
Telephone Number	:	352-422-7638
Fax Number	:

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

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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Directions to “ CLARKE AVELLANOSA ” Practice Location

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