Provider Demographics
NPI:1225413917
Name:GATEWAY PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:GATEWAY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MALHOIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-929-8077
Mailing Address - Street 1:6763 LAND O LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-3234
Mailing Address - Country:US
Mailing Address - Phone:813-929-8077
Mailing Address - Fax:813-929-8932
Practice Address - Street 1:6763 LAND O LAKES BLVD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-3234
Practice Address - Country:US
Practice Address - Phone:813-929-8077
Practice Address - Fax:813-929-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty