MEDICARE: NOLAN AMUSO DPT

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	28365	FL

General Provider Information

NPI Number	:	1598105355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOLAN AMUSO DPT

Provider Business Mailing Address
First Line	:	3451 TECHNOLOGICAL AVE
Second Line	:	SUITE 1
City	:	ORLANDO
State	:	FL
Zip	:	32817-8353
Country	:	US
Telephone Number	:	407-681-2520
Fax Number	:	407-249-1414

Provider Business Practice Location Address
First Line	:	3451 TECHNOLOGICAL AVE
Second Line	:	SUITE 1
City	:	ORLANDO
State	:	FL
Zip	:	32817-8353
Country	:	US
Telephone Number	:	407-681-2520
Fax Number	:	407-249-1414

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	06/26/2013

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