Healthcare Provider Details

I. General information

NPI: 1124545892
Provider Name (Legal Business Name): NADIA GADDIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 WARE ARCHWAY CT
BRANDON FL
33510-3308
US

IV. Provider business mailing address

215 WARE ARCHWAY CT
BRANDON FL
33510-3308
US

V. Phone/Fax

Practice location:
  • Phone: 813-364-2307
  • Fax: 813-200-1789
Mailing address:
  • Phone: 813-364-2307
  • Fax: 813-200-1789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT32992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: