Shelly Fonseca, | |
19008 Avenue Bayonnes, Lutz, FL 33558-5356 | |
(305) 469-5014 | |
Not Available |
Full Name | Shelly Fonseca |
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Gender | Female |
Speciality | Physical Therapist |
Location | 19008 Avenue Bayonnes, Lutz, Florida |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1174060305 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 10331 (Florida) | Primary |
Provider Name | Florida Luna Care Physical Therapy Llc |
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Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
Provider Identifiers | NPI Number: 1114542032 PECOS PAC ID: 3779991559 Enrollment ID: O20210415001126 |
Mailing Address | Practice Location Address |
---|---|
Shelly Fonseca, 19008 Avenue Bayonnes, Lutz, FL 33558-5356 Ph: (305) 469-5014 | Shelly Fonseca, 19008 Avenue Bayonnes, Lutz, FL 33558-5356 Ph: (305) 469-5014 |
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