MEDICARE: AUSTIN GABBARD PTA

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	225200000X	Physical Therapy Assistant	PTA25951	FL

General Provider Information

NPI Number	:	1497123814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN GABBARD PTA

Provider Business Mailing Address
First Line	:	881 W BLOXHAM ST
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-3119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5155 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-8170
Country	:	US
Telephone Number	:	561-637-7195
Fax Number	:

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

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	09/02/2015

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