MEDICARE: IDLER BONHOMME LMT MPT

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	225700000X	Massage Therapist	MA32752	FL
2	225100000X	Physical Therapist	PT21887	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	:	1427008556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDLER BONHOMME LMT MPT

Provider Business Mailing Address
First Line	:	PO BOX 680735
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32868-0735
Country	:	US
Telephone Number	:	321-369-9133
Fax Number	:	888-696-1020

Provider Business Practice Location Address
First Line	:	6388 SILVER STAR RD STE 1E
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-3235
Country	:	US
Telephone Number	:	321-369-9133
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	01/05/2021

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