MEDICARE: MICHAEL LEOPOLD 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	PT20242	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6697851	OTHER	FL	GHI
2	Y034U	OTHER	FL	BCBS OF FLORIDA

General Provider Information

NPI Number	:	1043283864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LEOPOLD PT

Provider Business Mailing Address
First Line	:	7111 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2906
Country	:	US
Telephone Number	:	561-966-7950
Fax Number	:

Provider Business Practice Location Address
First Line	:	7111 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2906
Country	:	US
Telephone Number	:	561-966-7950
Fax Number	:

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	02/22/2011

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