MEDICARE: BANU MELISSA ACAN DPT

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	9170	MN
2	225100000X	Physical Therapist	30466	FL

General Provider Information

NPI Number	:	1295079440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BANU MELISSA ACAN DPT

Provider Business Mailing Address
First Line	:	7357 INTERNATIONAL PL
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34240-8427
Country	:	US
Telephone Number	:	941-500-9292
Fax Number	:	941-500-9292

Provider Business Practice Location Address
First Line	:	7357 INTERNATIONAL PL
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34240-8427
Country	:	US
Telephone Number	:	941-500-9292
Fax Number	:	941-500-9292

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

Provider Enumeration Date	:	11/11/2012
Last Update Date	:	01/29/2020

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Directions to “ BANU MELISSA ACAN DPT” Practice Location

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