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NPI Code Detail

MEDICARE: MARIA FORNOLES

MEDICARE: MARIA FORNOLES
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
1225100000XPhysical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT16796OTHERFLLICENSE #

General Provider Information

NPI Number : 1225146822
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA FORNOLES
Provider Business Mailing Address
First Line : 600 RIVER BIRCH CT APT 336
Second Line :
City : CLERMONT
State : FL
Zip : 34711-5146
Country : US
Telephone Number : 407-617-7621
Fax Number :
Provider Business Practice Location Address
First Line : 706 E GRAND HWY
Second Line :
City : CLERMONT
State : FL
Zip : 34711-3708
Country : US
Telephone Number : 352-242-0900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 07/08/2007

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Directions to “ MARIA FORNOLES ” Practice Location

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