MEDICARE: PHILIP GUY GOTARDO PT

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	225100000X	Physical Therapist	1111961	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225081169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP GUY GOTARDO PT

Provider Business Mailing Address
First Line	:	PO BOX 66308
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77266-6308
Country	:	US
Telephone Number	:	713-830-3033
Fax Number	:	713-523-4897

Provider Business Practice Location Address
First Line	:	3311 RICHMOND AVE
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77098
Country	:	US
Telephone Number	:	713-830-3033
Fax Number	:	713-523-4897

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	05/02/2011

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