MEDICARE: MISS MARIA ANGELA LONTOC FOX RPT

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	1210133	TX

General Provider Information

NPI Number	:	1356610653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIA ANGELA LONTOC FOX RPT

Provider Business Mailing Address
First Line	:	1126 BERKMAN CIR
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-6311
Country	:	US
Telephone Number	:	407-610-9673
Fax Number	:

Provider Business Practice Location Address
First Line	:	12124 HIGH TECH AVE
Second Line	:	STE.300
City	:	ORLANDO
State	:	FL
Zip	:	32817-8373
Country	:	US
Telephone Number	:	407-249-6049
Fax Number	:

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

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	02/20/2023

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