MEDICARE: MR. NEPTHALI TITUS TABANCURA P.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	225100000X	Physical Therapist	PT25296	FL

General Provider Information

NPI Number	:	1265703227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NEPTHALI TITUS TABANCURA P.T.

Provider Business Mailing Address
First Line	:	3901 GARDEN PLAZA WAY
Second Line	:	APT. 6124
City	:	ORLANDO
State	:	FL
Zip	:	32837-2308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 GARDEN PLAZA WAY
Second Line	:	APT. 6124
City	:	ORLANDO
State	:	FL
Zip	:	32837-2308
Country	:	US
Telephone Number	:	360-791-0039
Fax Number	:

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

Provider Enumeration Date	:	01/23/2012
Last Update Date	:	01/23/2012

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