Provider Demographics
NPI:1376678383
Name:MERRITT, AUDREY LIBERTY (PT)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:LIBERTY
Last Name:MERRITT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:AUDREY
Other - Middle Name:ELLEN
Other - Last Name:LIBERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4113 NW 6TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-0731
Mailing Address - Country:US
Mailing Address - Phone:352-376-6300
Mailing Address - Fax:352-372-0661
Practice Address - Street 1:4113C NW 6TH ST STE C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-1749
Practice Address - Country:US
Practice Address - Phone:352-376-6300
Practice Address - Fax:352-372-0661
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1105245225100000X
FL31410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31410OtherPHYSICAL THERAPY LICENSE