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General NPI Number Information
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NPI Number | 1699890962
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Entity Type | Individual
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Provider Name | GREGORY CHARLES MAGDA P.T.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5627 9TH ST E
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City | BRADENTON
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State | FL
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Zip | 34203-6105
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Country | US
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Telephone | 941-753-8941
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Fax |
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Provider Business Mailing Address
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Address Line | 5719 FIRESTONE CT
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City | SARASOTA
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State | FL
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Zip | 34238-5746
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Country | US
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Telephone | 509-680-2122
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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 | PT22529
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License Number State | FL
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