MEDICARE: LISA MARIE LEPINE PT, DPT

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	35628	FL

General Provider Information

NPI Number	:	1144841883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE LEPINE PT, DPT

Provider Business Mailing Address
First Line	:	172 COUNTY ROUTE 63
Second Line	:
City	:	OSWEGO
State	:	NY
Zip	:	13126-5100
Country	:	US
Telephone Number	:	315-529-8724
Fax Number	:

Provider Business Practice Location Address
First Line	:	1495 S VOLUSIA AVE STE 101
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7047
Country	:	US
Telephone Number	:	386-401-6100
Fax Number	:	386-960-0551

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

Provider Enumeration Date	:	05/05/2020
Last Update Date	:	05/08/2020

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