Healthcare Provider Details

I. General information

NPI: 1841370806
Provider Name (Legal Business Name): NICHOLAS GAZO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 SUNSET DR 405
SOUTH MIAMI FL
33143-5166
US

IV. Provider business mailing address

5975 SUNSET DR 405
SOUTH MIAMI FL
33143-5166
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-8040
  • Fax: 305-661-8891
Mailing address:
  • Phone: 305-661-8040
  • Fax: 305-661-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 19322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: