Healthcare Provider Details

I. General information

NPI: 1104090364
Provider Name (Legal Business Name): ROBERT STUART GAILEY JR. PHD, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7641 SW 126TH ST
MIAMI FL
33156-6013
US

IV. Provider business mailing address

7641 SW 126TH ST
MIAMI FL
33156-6013
US

V. Phone/Fax

Practice location:
  • Phone: 305-378-0855
  • Fax: 305-378-4107
Mailing address:
  • Phone: 305-378-0855
  • Fax: 305-378-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number003325
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number003325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: