Healthcare Provider Details

I. General information

NPI: 1194879577
Provider Name (Legal Business Name): MR. MARTIN O HUEGEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 NEWBERRY RD
GAINESVILLE FL
32607
US

IV. Provider business mailing address

3038 SW 91ST TERR
GAINESVILLE FL
32608
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-2116
  • Fax: 352-373-1507
Mailing address:
  • Phone: 352-870-1031
  • Fax: 352-331-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: