MEDICARE: ERIN PISAURO LPTA

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	PTA22463	FL

General Provider Information

NPI Number	:	1780197459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN PISAURO LPTA

Provider Business Mailing Address
First Line	:	600 N HIGHWAY 27 STE 5
Second Line	:
City	:	MINNEOLA
State	:	FL
Zip	:	34715-6265
Country	:	US
Telephone Number	:	352-678-3419
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N HIGHWAY 27 STE 5
Second Line	:
City	:	MINNEOLA
State	:	FL
Zip	:	34715-6265
Country	:	US
Telephone Number	:	352-678-3419
Fax Number	:

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

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	11/15/2017

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