MEDICARE: ANTHONY JOSEPH DIMAIO JR. 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	003152	WV
2	225100000X	Physical Therapist	28312	FL

General Provider Information

NPI Number	:	1205273026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY JOSEPH DIMAIO JR. DPT

Provider Business Mailing Address
First Line	:	4151 AUDUBON OAKS CIR BLDG 12
Second Line	:	APARTMENT # 305
City	:	LAKELAND
State	:	FL
Zip	:	33809-5941
Country	:	US
Telephone Number	:	301-876-1988
Fax Number	:

Provider Business Practice Location Address
First Line	:	11754 MARTIN LUTHER KING BLVD E
Second Line	:
City	:	SEFFNER
State	:	FL
Zip	:	33584-4923
Country	:	US
Telephone Number	:	813-661-8267
Fax Number	:

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

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	03/17/2014

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