MEDICARE: MS. LILLIAN TALIAFERRO 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		NY

General Provider Information

NPI Number	:	1053646034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LILLIAN TALIAFERRO P.T.

Provider Business Mailing Address
First Line	:	10571 FLATLANDS 9 STREET
Second Line	:
City	:	BROOKLYN, NEW YORK
State	:	NY
Zip	:	11236-4623
Country	:	US
Telephone Number	:	347-886-6694
Fax Number	:

Provider Business Practice Location Address
First Line	:	10571 FLATLANDS 9 STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11236-4623
Country	:	US
Telephone Number	:	347-886-6694
Fax Number	:

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

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	10/09/2009

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