MEDICARE: MR. LEE ALLEN GREENBERG CPO/LPO

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	222Z00000X	Orthotist	POR 140	FL
2	224P00000X	Prosthetist	POR 140	FL

General Provider Information

NPI Number	:	1992990105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEE ALLEN GREENBERG CPO/LPO

Provider Business Mailing Address
First Line	:	5311 E FLETCHER AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-1147
Country	:	US
Telephone Number	:	813-985-5000
Fax Number	:	813-985-4499

Provider Business Practice Location Address
First Line	:	3343 TAMPA RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3426
Country	:	US
Telephone Number	:	727-785-0100
Fax Number	:	727-785-7773

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

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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