MEDICARE: MR. LONNY REEBER MPT

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	20058	FL

General Provider Information

NPI Number	:	1083652507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LONNY REEBER MPT

Provider Business Mailing Address
First Line	:	2001NE48TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4517
Country	:	US
Telephone Number	:	954-491-6620
Fax Number	:	954-491-6627

Provider Business Practice Location Address
First Line	:	3461 MERRICK LN
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-8245
Country	:	US
Telephone Number	:	954-935-9354
Fax Number	:

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	10/13/2015

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