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General NPI Number Information
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NPI Number | 1366848921
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Entity Type | Individual
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Provider Name | JAIME GOLD DPT
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Gender | Female
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 508 ANTIOCH AVE APT 9
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City | FT LAUDERDALE
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State | FL
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Zip | 33304-3940
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Country | US
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Telephone | 614-374-5394
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Fax |
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Provider Business Mailing Address
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Address Line | 508 ANTIOCH AVE APT 9
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City | FT LAUDERDALE
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State | FL
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Zip | 33304-3940
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT29597
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL.00012966
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License Number State | CO
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