MEDICARE: MRS. MARIELYNE P CUOMO L/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	PTA16361	FL

General Provider Information

NPI Number	:	1689965972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIELYNE P CUOMO L/PTA

Provider Business Mailing Address
First Line	:	9800 BALSARIDGE CT
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-4913
Country	:	US
Telephone Number	:	727-376-6331
Fax Number	:

Provider Business Practice Location Address
First Line	:	8050 OLD CR 54
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6457
Country	:	US
Telephone Number	:	727-375-0600
Fax Number	:	727-375-1117

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

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	04/21/2011

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