Mark Waller, PT | |
11742 Eros Rd, Lehigh Acres, FL 33971-3759 | |
(239) 671-8962 | |
Not Available |
Full Name | Mark Waller |
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Gender | Male |
Speciality | Physical Therapist |
Location | 11742 Eros Rd, Lehigh Acres, Florida |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1801525381 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 16250 (Florida) | Primary |
Provider Name | Legacy Healthcare Services Inc |
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Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1336535988 PECOS PAC ID: 2163339722 Enrollment ID: O20150805009289 |
Mailing Address | Practice Location Address |
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Mark Waller, PT 11742 Eros Rd, Lehigh Acres, FL 33971-3759 Ph: (239) 671-8962 | Mark Waller, PT 11742 Eros Rd, Lehigh Acres, FL 33971-3759 Ph: (239) 671-8962 |
Margarita Harris, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 4316 Lee Blvd, 12a & 12b, Lehigh Acres, FL 33971 Phone: 239-368-7744 Fax: 239-368-7824 | |
Bopinder Singh, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1150 Lee Blvd Ste 3, Lehigh Acres, FL 33936 Phone: 239-369-3799 | |
Peter Armetta, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 4316 Lee Blvd Unit 12b, Lehigh Acres, FL 33971 Phone: 239-368-7744 Fax: 239-368-7824 | |
Mrs. Emily Ann Kupper, PT, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 2724 5th St W Ste A, Lehigh Acres, FL 33971 Phone: 239-303-1501 Fax: 888-803-9101 | |
Dr. Daniel Juan Alvarez, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 3507 Lee Blvd Ste 101, Lehigh Acres, FL 33971 Phone: 123-925-6326 | |
Katherine Anne Sellaroli, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 4316 Lee Blvd Unit 12b, Lehigh Acres, FL 33971 Phone: 239-368-7744 | |
James Moore, Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 4316 Lee Blvd, 12b, Lehigh Acres, FL 33971 Phone: 239-368-7744 Fax: 239-368-7824 |