MEDICARE: MR. ROBERT GEORGE ANTHONY LAING

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	PTA 18437	FL

General Provider Information

NPI Number	:	1811268972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT GEORGE ANTHONY LAING

Provider Business Mailing Address
First Line	:	3735 EVANS AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9302
Country	:	US
Telephone Number	:	239-277-3977
Fax Number	:	239-277-5203

Provider Business Practice Location Address
First Line	:	3735 EVANS AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9302
Country	:	US
Telephone Number	:	239-277-3977
Fax Number	:	239-277-5203

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

Provider Enumeration Date	:	01/21/2012
Last Update Date	:	01/21/2012

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