MEDICARE: DR. LYNETTE MARIE CHORBA 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	2251P0200X	Pediatric Physical Therapist	24082	FL

General Provider Information

NPI Number	:	1619139003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNETTE MARIE CHORBA DPT

Provider Business Mailing Address
First Line	:	315 NE 3RD AVE APT 1707
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1682
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7522 WILES RD STE 208
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2056
Country	:	US
Telephone Number	:	954-840-0556
Fax Number	:

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

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	01/19/2011

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