MEDICARE: MRS. LILIANA P DEFIORE RPT

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

General Provider Information

NPI Number	:	1861460024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILIANA P DEFIORE RPT

Provider Business Mailing Address
First Line	:	4968 ROYAL GULF CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-7006
Country	:	US
Telephone Number	:	239-275-4411
Fax Number	:	239-275-6408

Provider Business Practice Location Address
First Line	:	4968 ROYAL GULF CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-7006
Country	:	US
Telephone Number	:	239-275-4411
Fax Number	:	239-275-6408

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/02/2014

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