MEDICARE: MATTHEW LUCENA PT

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	PT40429	FL

General Provider Information

NPI Number	:	1508644758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW LUCENA PT

Provider Business Mailing Address
First Line	:	PO BOX 36055
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-1202
Country	:	US
Telephone Number	:	888-488-8289
Fax Number	:	502-919-9780

Provider Business Practice Location Address
First Line	:	13563 NARCOOSSEE RD STE 120
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-7138
Country	:	US
Telephone Number	:	407-730-4240
Fax Number	:	407-887-1025

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

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/19/2023

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