Healthcare Provider Details

I. General information

NPI: 1760786891
Provider Name (Legal Business Name): ADAM GIST DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 WOODBINE RD STE D
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 NumberPT35727
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: