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NPI Code Detail

MEDICARE: MS. LILIBETH C LIBUNAO PT

MEDICARE: MS. LILIBETH C LIBUNAO PT
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
1225100000XPhysical TherapistPT 21873FL

General Provider Information

NPI Number : 1710970470
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LILIBETH C LIBUNAO PT
Provider Business Mailing Address
First Line : 3040 N WICKHAM RD
Second Line : SUITE 7
City : MELBOURNE
State : FL
Zip : 32935-2369
Country : US
Telephone Number : 321-255-9546
Fax Number : 321-255-4690
Provider Business Practice Location Address
First Line : 3040 N WICKHAM RD
Second Line : SUITE 7
City : MELBOURNE
State : FL
Zip : 32935-2369
Country : US
Telephone Number : 321-255-9546
Fax Number : 321-255-4690
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2005
Last Update Date : 07/08/2007

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