MEDICARE: MRS. GAIL A SOCHACKY-HERBERT

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	235Z00000X	Speech-Language Pathologist	SA5633	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20-2945722	OTHER	FL	ADVANCE REHAB TAX ID

General Provider Information

NPI Number	:	1124154778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GAIL A SOCHACKY-HERBERT

Provider Business Mailing Address
First Line	:	2195 JENKS AVE STE A
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4551
Country	:	US
Telephone Number	:	850-522-4770
Fax Number	:	850-769-2366

Provider Business Practice Location Address
First Line	:	2195 JENKS AVE STE A
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4551
Country	:	US
Telephone Number	:	850-522-4770
Fax Number	:	850-769-2366

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. GAIL A SOCHACKY-HERBERT ” Practice Location

Language	Start Address	Practice Location

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