MEDICARE: MR. PATRICK LESLIE TUTELO PTA

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	225200000X	Physical Therapy Assistant	2306601575	VA

General Provider Information

NPI Number	:	1245591304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK LESLIE TUTELO PTA

Provider Business Mailing Address
First Line	:	401 VETERANS RD
Second Line	:
City	:	MIDDLETOWN
State	:	VA
Zip	:	22645-1821
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 VETERANS RD
Second Line	:
City	:	MIDDLETOWN
State	:	VA
Zip	:	22645-1821
Country	:	US
Telephone Number	:	540-550-6479
Fax Number	:

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	06/06/2012

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