MEDICARE: LVN MEDICAL OFFICE AND PHYSICAL THERAPY CORP

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1366957326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LVN MEDICAL OFFICE AND PHYSICAL THERAPY CORP

Provider Business Mailing Address
First Line	:	1406 SE 46TH LN STE 10
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-8684
Country	:	US
Telephone Number	:	239-541-9150
Fax Number	:	239-541-9181

Provider Business Practice Location Address
First Line	:	1406 SE 46TH LN STE 10
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-8684
Country	:	US
Telephone Number	:	239-541-9150
Fax Number	:	239-541-9181

Authorized Official
Title or Position	:	VP
Name	:	YUDITH SIMON
Credential	:	ARNP
Telephone Number	:	305-803-4502

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	12/12/2017

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