MEDICARE: MISS MICHELINE ILANO CALOPE 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	26492	FL

General Provider Information

NPI Number	:	1124314984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELINE ILANO CALOPE PT

Provider Business Mailing Address
First Line	:	3201 W COMMERCIAL BLVD STE 116
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3444
Country	:	US
Telephone Number	:	954-675-7416
Fax Number	:

Provider Business Practice Location Address
First Line	:	3278 CORAL RIDGE DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3186
Country	:	US
Telephone Number	:	954-675-7416
Fax Number	:

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

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