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General NPI Number Information
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NPI Number | 1972875201
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Entity Type | Organization
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Legal Business Name | FLORIDA KEYS THERAPY LLC
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 100 HAMMOCKS TRL APT 2106
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City | KEY LARGO
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State | FL
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Zip | 33037-4860
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Country | US
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Telephone | 786-282-0387
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 371640
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City | KEY LARGO
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State | FL
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Zip | 33037-1640
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ANASTASSIA GIBSON
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Credential | DPT
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Telephone | 786-282-0387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT 25997
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License Number State | FL
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