MEDICARE: REQUEST PHYSICAL THERAPY

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	HCC1637	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	:	1245225085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REQUEST PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	4820 NEWBERRY ROAD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32609
Country	:	US
Telephone Number	:	352-373-2116
Fax Number	:	352-373-1507

Provider Business Practice Location Address
First Line	:	4820 NEWBERRY ROAD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32609
Country	:	US
Telephone Number	:	352-692-2155
Fax Number	:	352-371-9021

Authorized Official
Title or Position	:	ASSISTANT DIRECTOR
Name	:	MR. MICHAEL A LIGMANOWSKI
Credential	:	ATC
Telephone Number	:	352-373-2116

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	08/22/2020

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Directions to “REQUEST PHYSICAL THERAPY ” Practice Location

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