Healthcare Provider Details

I. General information

NPI: 1992302749
Provider Name (Legal Business Name): GAH2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 NEIGHBORHOOD MARKET RD STE 102
ORLANDO FL
32825-3525
US

IV. Provider business mailing address

222 NEIGHBORHOOD MARKET RD STE 102
ORLANDO FL
32825-3525
US

V. Phone/Fax

Practice location:
  • Phone: 407-530-0543
  • Fax:
Mailing address:
  • Phone: 407-530-0543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MANISH BHATT
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-443-0014