Provider Demographics
NPI:1417053547
Name:ROBERTS, GAIL COURTNEY (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:COURTNEY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:MRS
Other - First Name:GAIL
Other - Middle Name:C
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:929 HABEN BLVD
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-4163
Mailing Address - Country:US
Mailing Address - Phone:941-729-9320
Mailing Address - Fax:941-723-6368
Practice Address - Street 1:929 HABEN BLVD
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-4163
Practice Address - Country:US
Practice Address - Phone:941-729-9320
Practice Address - Fax:941-723-6368
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA15140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C5910OtherBLUE SHIELD PROVIDER