Provider Demographics
NPI:1487690467
Name:LANUSSE, PAUL ROBERT (RPT, OTR/L)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBERT
Last Name:LANUSSE
Suffix:
Gender:M
Credentials:RPT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 CUMMINGS ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4889
Mailing Address - Country:US
Mailing Address - Phone:321-662-9269
Mailing Address - Fax:407-386-6132
Practice Address - Street 1:864 BLAIRMONT LN
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7027
Practice Address - Country:US
Practice Address - Phone:321-662-9269
Practice Address - Fax:407-386-6132
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21068225100000X
MI5501012670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP31000001Medicare ID - Type UnspecifiedMEMBER#
FLU3329ZMedicare ID - Type UnspecifiedPT PROVIDER NUMBER