Healthcare Provider Details

I. General information

NPI: 1124827159
Provider Name (Legal Business Name): ISABELLA WALDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 NEWBERRY RD
GAINESVILLE FL
32607-2249
US

IV. Provider business mailing address

24203 NW 94TH AVE
ALACHUA FL
32615-7813
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-2116
  • Fax:
Mailing address:
  • Phone: 352-262-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number33964
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: