Healthcare Provider Details

I. General information

NPI: 1821914185
Provider Name (Legal Business Name): ITUMELENG GABASIANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5867 E COUNTY ROAD 466
THE VILLAGES FL
32162-3605
US

IV. Provider business mailing address

2053 CAROLINA AVE
GOTHA FL
34734-5026
US

V. Phone/Fax

Practice location:
  • Phone: 844-502-7996
  • Fax:
Mailing address:
  • Phone: 269-635-9422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT44281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: