MEDICARE: EERO ARVIID LAUKKANEN 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	PT0009524	FL

General Provider Information

NPI Number	:	1588062954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EERO ARVIID LAUKKANEN RPT

Provider Business Mailing Address
First Line	:	720 N DIXIE HWY APT 505
Second Line	:	505
City	:	LANTANA
State	:	FL
Zip	:	33462-1849
Country	:	US
Telephone Number	:	561-236-2098
Fax Number	:

Provider Business Practice Location Address
First Line	:	7408 LAKE WORTH RD
Second Line	:	500
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2502
Country	:	US
Telephone Number	:	561-432-3696
Fax Number	:

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

Provider Enumeration Date	:	12/16/2014
Last Update Date	:	12/16/2014

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