MEDICARE: MR. RICHARD PANCHO GAJO MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT18613	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033245287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD PANCHO GAJO MPT

Provider Business Mailing Address
First Line	:	10395 NARCOOSSEE RD E
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-6939
Country	:	US
Telephone Number	:	407-730-3244
Fax Number	:	407-730-3246

Provider Business Practice Location Address
First Line	:	3303 S SEMORAN BLVD
Second Line	:	STE 300
City	:	ORLANDO
State	:	FL
Zip	:	32822-2500
Country	:	US
Telephone Number	:	407-281-0228
Fax Number	:	407-281-0229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2007
Last Update Date	:	08/23/2016

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Directions to “ MR. RICHARD PANCHO GAJO MPT” Practice Location

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