MEDICARE: MS. LILLIAN FELICIANO PTA

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	225200000X	Physical Therapy Assistant	J2-0000483	DE
2	225200000X	Physical Therapy Assistant	TE005683L	PA

General Provider Information

NPI Number	:	1669419685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LILLIAN FELICIANO PTA

Provider Business Mailing Address
First Line	:	1922 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-2123
Country	:	US
Telephone Number	:	215-235-0582
Fax Number	:

Provider Business Practice Location Address
First Line	:	7125 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19135-1008
Country	:	US
Telephone Number	:	215-338-8900
Fax Number	:	215-338-8923

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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