=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407775828
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GILLIAN ANNA LACO DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2026
-----------------------------------------------------
Last Update Date | 07/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11661 STATE ROAD 70 E
-----------------------------------------------------
City | LAKEWOOD RANCH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34202-9416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-222-0321
-----------------------------------------------------
Fax | 941-957-2600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2619 58TH CIR E
-----------------------------------------------------
City | PALMETTO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34221-1285
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-576-4336
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PPT44935
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------