Healthcare Provider Details

I. General information

NPI: 1730879107
Provider Name (Legal Business Name): NICHOLAS PALUMBO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NICK PALUMBO PT

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17270 SE 109TH TERRACE RD
SUMMERFIELD FL
34491-9015
US

IV. Provider business mailing address

4500 NEWBERRY RD
GAINESVILLE FL
32607-2245
US

V. Phone/Fax

Practice location:
  • Phone: 352-336-6000
  • Fax:
Mailing address:
  • Phone: 352-336-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT40150
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: