MEDICARE: JOANNE LUMABAN BARAHONA 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	PT37193	FL

General Provider Information

NPI Number	:	1679144513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE LUMABAN BARAHONA DPT

Provider Business Mailing Address
First Line	:	3680 N WICKHAM RD STE B
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-2327
Country	:	US
Telephone Number	:	321-255-5500
Fax Number	:	251-255-5551

Provider Business Practice Location Address
First Line	:	3680 N WICKHAM RD STE B
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-2327
Country	:	US
Telephone Number	:	321-255-5500
Fax Number	:	321-255-5551

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

Provider Enumeration Date	:	07/01/2021
Last Update Date	:	07/11/2022

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