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General NPI Number Information
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NPI Number | 1689058125
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Entity Type | Organization
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Legal Business Name | ADVANCED PHYSICAL MEDICINE & REHAB
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 10/02/2015
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Provider Practice Location Address
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Address Line | 2835 ALT 19 SUITE B
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City | PALM HARBOR
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State | FL
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Zip | 34683-1926
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Country | US
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Telephone | 727-748-4742
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Fax | 727-748-4739
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Provider Business Mailing Address
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Address Line | 2835 ALT 19 SUITE B
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City | PALM HARBOR
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State | FL
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Zip | 34683-1926
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Country | US
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Telephone | 727-748-4742
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Fax | 727-748-4739
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GLOYDIAN CRUZ-GOMEZ
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Credential | M.D.
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Telephone | 727-748-4742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME110430
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License Number State | FL
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