Provider Demographics
NPI:1275078131
Name:SUSAN GAMMON PT, LLC
Entity Type:Organization
Organization Name:SUSAN GAMMON PT, LLC
Other - Org Name:PLANTATION PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-512-7068
Mailing Address - Street 1:5085 N BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-9032
Mailing Address - Country:US
Mailing Address - Phone:561-512-7068
Mailing Address - Fax:941-451-2073
Practice Address - Street 1:500 ROCKLEY BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-4300
Practice Address - Country:US
Practice Address - Phone:561-512-7068
Practice Address - Fax:941-451-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty