MEDICARE: MRS. MARIA LIEZL GELI ANDOOL P.T.

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	PT 23110	FL

General Provider Information

NPI Number	:	1689701336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA LIEZL GELI ANDOOL P.T.

Provider Business Mailing Address
First Line	:	427 LAKE JUNE DR
Second Line	:
City	:	LAKE PLACID
State	:	FL
Zip	:	33852-5655
Country	:	US
Telephone Number	:	863-202-5269
Fax Number	:	863-471-2015

Provider Business Practice Location Address
First Line	:	204 US HIGHWAY 27 NORTH
Second Line	:
City	:	LAKE PLACID
State	:	FL
Zip	:	33852-5655
Country	:	US
Telephone Number	:	863-465-9500
Fax Number	:	863-465-9542

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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