Provider Demographics
NPI:1811236169
Name:CARNEIRO, LENISSON MELO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LENISSON
Middle Name:MELO
Last Name:CARNEIRO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5208
Mailing Address - Country:US
Mailing Address - Phone:954-369-5787
Mailing Address - Fax:954-206-7733
Practice Address - Street 1:4324 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5208
Practice Address - Country:US
Practice Address - Phone:954-369-5787
Practice Address - Fax:954-206-7733
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist