Provider Demographics
NPI:1801366521
Name:DIMENSIONS PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:DIMENSIONS PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERLENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER-GONER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:228-623-7411
Mailing Address - Street 1:6010 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3436
Mailing Address - Country:US
Mailing Address - Phone:228-623-7411
Mailing Address - Fax:
Practice Address - Street 1:6010 AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3436
Practice Address - Country:US
Practice Address - Phone:228-623-7411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29586OtherPT