Healthcare Provider Details

I. General information

NPI: 1457396699
Provider Name (Legal Business Name): DIANNE SWANSON GAINES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 S STATE ROAD 19
PALATKA FL
32177-9397
US

IV. Provider business mailing address

125 RIVERS EDGE DR
EAST PALATKA FL
32131-4310
US

V. Phone/Fax

Practice location:
  • Phone: 386-336-9028
  • Fax:
Mailing address:
  • Phone: 386-328-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 0003378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: