Provider Demographics
NPI:1205118932
Name:DE LAAF, GASPARD ALBERT JEAN (PT)
Entity type:Individual
Prefix:MR
First Name:GASPARD
Middle Name:ALBERT JEAN
Last Name:DE LAAF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 CAROLYN DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6210
Mailing Address - Country:US
Mailing Address - Phone:727-207-8399
Mailing Address - Fax:727-232-0685
Practice Address - Street 1:8401 CAROLYN DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6210
Practice Address - Country:US
Practice Address - Phone:727-207-8399
Practice Address - Fax:727-232-0685
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 11918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist