MEDICARE: GENE THOMAS DRISKILL I PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	24530	FL

General Provider Information

NPI Number	:	1083175418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENE THOMAS DRISKILL I PTA

Provider Business Mailing Address
First Line	:	5750 ILLINOIS AVE
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-2836
Country	:	US
Telephone Number	:	865-556-2317
Fax Number	:

Provider Business Practice Location Address
First Line	:	5750 ILLINOIS AVE
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-2836
Country	:	US
Telephone Number	:	865-556-2317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	03/28/2019

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