Healthcare Provider Details

I. General information

NPI: 1619822434
Provider Name (Legal Business Name): ADAM GIST PT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 WOODBINE RD
PACE FL
32571-8768
US

IV. Provider business mailing address

5437 SOUTHLAKE DR
PACE FL
32571-7007
US

V. Phone/Fax

Practice location:
  • Phone: 850-857-3380
  • Fax: 844-412-2128
Mailing address:
  • Phone: 850-857-3380
  • Fax: 844-412-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ADAM GIST
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 850-857-3380