Healthcare Provider Details

I. General information

NPI: 1568346252
Provider Name (Legal Business Name): JOCELYN AMBER GAGNON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4593 S DALE MABRY HWY SUITE 110
TAMPA FL
33611
US

IV. Provider business mailing address

645 1ST CROWN POINT RD
STRAFFORD NH
03884-6116
US

V. Phone/Fax

Practice location:
  • Phone: 813-250-1208
  • Fax:
Mailing address:
  • Phone: 603-833-9968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6009
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number214300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: