MEDICARE: MR. BRIAN ANTHONY SORBELLO L.M.T.

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	225700000X	Massage Therapist	MA28571	FL

General Provider Information

NPI Number	:	1245363241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN ANTHONY SORBELLO L.M.T.

Provider Business Mailing Address
First Line	:	5331 SUMMERLIN RD
Second Line	:	# 9
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7684
Country	:	US
Telephone Number	:	239-443-8205
Fax Number	:

Provider Business Practice Location Address
First Line	:	823 LAKE MCGREGOR DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-6209
Country	:	US
Telephone Number	:	239-443-8205
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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