MEDICARE: MRS. LAUREN MICHELLE CASANOVA 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	PTA20720	FL

General Provider Information

NPI Number	:	1730229204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN MICHELLE CASANOVA PTA

Provider Business Mailing Address
First Line	:	419 PLOVER AVE
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-3924
Country	:	US
Telephone Number	:	305-442-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S DOUGLAS RD
Second Line	:	SUITE 210
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4108
Country	:	US
Telephone Number	:	305-448-0146
Fax Number	:	305-448-0147

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	04/12/2012

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