Provider Demographics
NPI:1528194776
Name:GAMBARO, ROBERT JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:GAMBARO
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 OAKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4315
Mailing Address - Country:US
Mailing Address - Phone:727-422-0329
Mailing Address - Fax:
Practice Address - Street 1:1247 OAKVIEW AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4315
Practice Address - Country:US
Practice Address - Phone:727-422-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0014717225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist