Provider Demographics
NPI:1033245287
Name:GAJO, RICHARD PANCHO (MPT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PANCHO
Last Name:GAJO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
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Mailing Address - Street 1:10395 NARCOOSSEE RD E
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6939
Mailing Address - Country:US
Mailing Address - Phone:407-730-3244
Mailing Address - Fax:407-730-3246
Practice Address - Street 1:3303 S SEMORAN BLVD
Practice Address - Street 2:STE 300
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2500
Practice Address - Country:US
Practice Address - Phone:407-281-0228
Practice Address - Fax:407-281-0229
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT18613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist