Provider Demographics
NPI:1992990105
Name:GREENBERG, LEE ALLEN (CPO/LPO)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:ALLEN
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:CPO/LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5311 E FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1147
Mailing Address - Country:US
Mailing Address - Phone:813-985-5000
Mailing Address - Fax:813-985-4499
Practice Address - Street 1:3343 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3426
Practice Address - Country:US
Practice Address - Phone:727-785-0100
Practice Address - Fax:727-785-7773
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR 140222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0179970001Medicare NSC