MEDICARE: ANGELA BARONE LIPSON

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	19575	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT19575	OTHER	FL	PT LICENSE

General Provider Information

NPI Number	:	1992282743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA BARONE LIPSON

Provider Business Mailing Address
First Line	:	10106 CLUBHOUSE TURN RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33449-5452
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10106 CLUBHOUSE TURN RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33449-5452
Country	:	US
Telephone Number	:	561-856-0259
Fax Number	:

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

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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