Provider Demographics
NPI:1295853786
Name:ALICEA-YILDIRIM, LENIS JANNIL (PT,MED)
Entity Type:Individual
Prefix:
First Name:LENIS
Middle Name:JANNIL
Last Name:ALICEA-YILDIRIM
Suffix:
Gender:F
Credentials:PT,MED
Other - Prefix:
Other - First Name:LENIS
Other - Middle Name:JANNIL
Other - Last Name:ALICEA-BENITEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12963 ENTRADA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4617
Mailing Address - Country:US
Mailing Address - Phone:321-229-4403
Mailing Address - Fax:
Practice Address - Street 1:12963 ENTRADA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4617
Practice Address - Country:US
Practice Address - Phone:321-229-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist