MEDICARE: MS. AMY JO GOMES R.P.T.

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	2251P0200X	Pediatric Physical Therapist	PT2879	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144317595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY JO GOMES R.P.T.

Provider Business Mailing Address
First Line	:	12118 CYPRESS LN
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-8591
Country	:	US
Telephone Number	:	352-406-0922
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 S HIGHWAY 27 STE B201
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-6816
Country	:	US
Telephone Number	:	352-394-0212
Fax Number	:	352-241-6361

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/29/2024

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