Provider Demographics
NPI:1093822173
Name:GAINESVILLE PHYSICAL THERAPY AND REHABILITATION SERVICES INC
Entity Type:Organization
Organization Name:GAINESVILLE PHYSICAL THERAPY AND REHABILITATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIBEKE
Authorized Official - Middle Name:
Authorized Official - Last Name:VALA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-376-6300
Mailing Address - Street 1:1234 NW 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4042
Mailing Address - Country:US
Mailing Address - Phone:352-376-6300
Mailing Address - Fax:352-372-0661
Practice Address - Street 1:1234 NW 14TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4042
Practice Address - Country:US
Practice Address - Phone:352-376-6300
Practice Address - Fax:352-372-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3509225100000X
FLPT12687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9125OtherBLUE CROSS BLUE SHIELD
FLY9125OtherBLUE CROSS BLUE SHIELD