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General NPI Number Information
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NPI Number | 1962908194
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Entity Type | Organization
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Legal Business Name | RAINBOW RIVER HEARING & BALANCE, INC.
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 20170 E PENNSYLVANIA AVE
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City | DUNNELLON
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State | FL
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Zip | 34432-6032
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Country | US
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Telephone | 352-462-7003
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Fax | 352-496-3053
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Provider Business Mailing Address
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Address Line | PO BOX 3293
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City | DUNNELLON
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State | FL
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Zip | 34430-3293
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Country | US
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Telephone | 352-462-7003
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Fax | 833-252-6409
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Authorized Official
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Title or Position | AUDIOLOGIST/PRESIDENT
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Name | DR. LISA NICOLE GASCAY
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Credential | AUD
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Telephone | 352-462-7003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AY2077
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License Number State | FL
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