MEDICARE: MRS. LUCIA LORETO MESIAS TORO 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	PT25192	FL
2	225100000X	Physical Therapist	2305212770	VA

General Provider Information

NPI Number	:	1790085272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LUCIA LORETO MESIAS TORO P.T

Provider Business Mailing Address
First Line	:	1239 SPRING HILL RD
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-2307
Country	:	US
Telephone Number	:	571-432-2980
Fax Number	:	703-734-2139

Provider Business Practice Location Address
First Line	:	1239 SPRING HILL RD
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-2307
Country	:	US
Telephone Number	:	571-432-2980
Fax Number	:	703-734-2139

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

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	03/17/2020

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