MEDICARE: MISS ANNALISA DORY TORRES SR. MSPT

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	010460	OH

General Provider Information

NPI Number	:	1649392630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANNALISA DORY TORRES SR. MSPT

Provider Business Mailing Address
First Line	:	3324 MARVIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-2133
Country	:	US
Telephone Number	:	216-661-0669
Fax Number	:

Provider Business Practice Location Address
First Line	:	18621 NEFF RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-3018
Country	:	US
Telephone Number	:	216-486-0268
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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