Provider Demographics
NPI:1407311467
Name:DOZE, GORGETTE WAHIB I (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:GORGETTE
Middle Name:WAHIB
Last Name:DOZE
Suffix:I
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11903 68TH ST
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-3510
Mailing Address - Country:US
Mailing Address - Phone:727-421-7038
Mailing Address - Fax:727-587-0059
Practice Address - Street 1:11903 68TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-3510
Practice Address - Country:US
Practice Address - Phone:727-421-7038
Practice Address - Fax:727-587-0059
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFIZ376192311465OtherBLUE CROSS BLUE SHIELD