=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154467355
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLORIA J BONE PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1725 E BAY DR
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33771-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-582-9665
-----------------------------------------------------
Fax | 727-582-9865
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 LA HACIENDA DR
-----------------------------------------------------
City | INDIAN ROCKS BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33785-3715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-582-9665
-----------------------------------------------------
Fax | 727-582-9865
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | 3367
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------