Provider Demographics
NPI:1952304693
Name:REED, GAYLE (MA, PT)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:MA, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14400 LEE RD
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-7400
Mailing Address - Country:US
Mailing Address - Phone:941-776-1290
Mailing Address - Fax:941-776-2528
Practice Address - Street 1:12159 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8678
Practice Address - Country:US
Practice Address - Phone:941-776-5585
Practice Address - Fax:941-776-5655
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-25
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY012HOtherBLUE CROSS BLUE SHIELD
FLY012HOtherBLUE CROSS BLUE SHIELD