Provider Demographics
NPI:1003187725
Name:GERVERA, VINCENT STEPHEN III (DPT)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:STEPHEN
Last Name:GERVERA
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 REDTAIL ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-6680
Mailing Address - Country:US
Mailing Address - Phone:850-441-3285
Mailing Address - Fax:
Practice Address - Street 1:2316 W 23RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2345
Practice Address - Country:US
Practice Address - Phone:850-522-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist