Provider Demographics
NPI:1316143381
Name:LIN, MENN LI (PT)
Entity type:Individual
Prefix:
First Name:MENN LI
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 S VOLUSIA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763
Mailing Address - Country:US
Mailing Address - Phone:386-774-6333
Mailing Address - Fax:386-774-6441
Practice Address - Street 1:2501 S VOLUSIA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763
Practice Address - Country:US
Practice Address - Phone:386-774-6333
Practice Address - Fax:386-774-6441
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY923LOtherBCBS FACILITY PO
FL1720155997OtherGROUP NPI
FL1869541OtherGROUP MAILHANDLERS
FLY923DOtherBCBS FACILITY OC
FL593586094OtherGROUP TAX ID
FLCH2068OtherGROUP CHAMPUS #
FL2381853OtherGROUP AETNA #
FLY926BOtherBCBS FACILITY OB
FLE3341ZMedicare ID - Type Unspecified