Healthcare Provider Details

I. General information

NPI: 1144573320
Provider Name (Legal Business Name): GERARDO MA FLORES THOMAS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12170 CORTEZ BLVD
BROOKSVILLE FL
34613-5578
US

IV. Provider business mailing address

7139 CALIFORNIA ST
BROOKSVILLE FL
34604-8409
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-5100
  • Fax:
Mailing address:
  • Phone: 352-346-7977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT9937
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: