Healthcare Provider Details

I. General information

NPI: 1013917269
Provider Name (Legal Business Name): WILLIAM SCOTT BARNETT I LAC PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 NW 39TH AVE
GAINESVILLE FL
32605-2263
US

IV. Provider business mailing address

2730 NW 39TH AVE
GAINESVILLE FL
32605-2263
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1320
  • Fax: 352-376-1340
Mailing address:
  • Phone: 352-376-1320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT4135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: