MEDICARE: LEELA LORTZ

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	106S00000X	Behavior Technician	RBT-23-275867	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356034805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEELA LORTZ

Provider Business Mailing Address
First Line	:	4947 CYPRESS TRACE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-6909
Country	:	US
Telephone Number	:	352-442-7543
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 S MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3131
Country	:	US
Telephone Number	:	813-842-6227
Fax Number	:

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

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	05/31/2023

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