Healthcare Provider Details

I. General information

NPI: 1457928442
Provider Name (Legal Business Name): JOHN MICHAEL DELOACH PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 NW 16TH AVE
GAINESVILLE FL
32601-4674
US

IV. Provider business mailing address

2912 NW 50TH TER
GAINESVILLE FL
32606-6065
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-7337
  • Fax:
Mailing address:
  • Phone: 561-252-5183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTT37273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: