MEDICARE: MISS DEBORAH T. MOURA R.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	5845	FL

General Provider Information

NPI Number	:	1285779280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DEBORAH T. MOURA R.P.T.

Provider Business Mailing Address
First Line	:	650 DOUGLAS AVE
Second Line	:	SUITE 1029
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2593
Country	:	US
Telephone Number	:	321-228-9050
Fax Number	:	407-869-0821

Provider Business Practice Location Address
First Line	:	650 DOUGLAS AVE
Second Line	:	SUITE 1029
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2593
Country	:	US
Telephone Number	:	321-228-9050
Fax Number	:	407-869-0821

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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