MEDICARE: LENISSON MELO CARNEIRO PT, DPT

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	PT28107	FL

General Provider Information

NPI Number	:	1811236169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENISSON MELO CARNEIRO PT, DPT

Provider Business Mailing Address
First Line	:	4324 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5208
Country	:	US
Telephone Number	:	954-369-5787
Fax Number	:	954-206-7733

Provider Business Practice Location Address
First Line	:	4324 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5208
Country	:	US
Telephone Number	:	954-369-5787
Fax Number	:	954-206-7733

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

Provider Enumeration Date	:	02/06/2013
Last Update Date	:	06/02/2021

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