MEDICARE: MR. JEFFERY DON GILLIAM 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	PT5040	FL

General Provider Information

NPI Number	:	1417003989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFERY DON GILLIAM PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	7525 SW 47 LANE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608
Country	:	US
Telephone Number	:	352-335-4199
Fax Number	:

Provider Business Practice Location Address
First Line	:	4820 NEWBERRY ROAD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607
Country	:	US
Telephone Number	:	352-373-2116
Fax Number	:	352-373-1507

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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