=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619822434
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADAM GIST PT, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2026
-----------------------------------------------------
Last Update Date | 02/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5565 WOODBINE RD
-----------------------------------------------------
City | PACE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32571-8768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-857-3380
-----------------------------------------------------
Fax | 844-412-2128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5437 SOUTHLAKE DR
-----------------------------------------------------
City | PACE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32571-7007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-857-3380
-----------------------------------------------------
Fax | 844-412-2128
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | ADAM GIST
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 850-857-3380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------