Healthcare Provider Details

I. General information

NPI: 1083175418
Provider Name (Legal Business Name): GENE THOMAS DRISKILL I PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 ILLINOIS AVE
NEW PORT RICHEY FL
34652-2836
US

IV. Provider business mailing address

5750 ILLINOIS AVE
NEW PORT RICHEY FL
34652-2836
US

V. Phone/Fax

Practice location:
  • Phone: 865-556-2317
  • Fax:
Mailing address:
  • Phone: 865-556-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number24530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: