=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093822173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAINESVILLE PHYSICAL THERAPY AND REHABILITATION SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1234 NW 14TH AVE
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32601-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-376-6300
-----------------------------------------------------
Fax | 352-372-0661
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1234 NW 14TH AVE
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32601-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-376-6300
-----------------------------------------------------
Fax | 352-372-0661
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRESIDENT
-----------------------------------------------------
Name | MRS. VIBEKE VALA
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 352-376-6300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT3509
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT12687
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------