MEDICARE: MICHAELA PATRICE GAITHER DPT

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	8523	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8523	OTHER	AZ	LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508097254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA PATRICE GAITHER DPT

Provider Business Mailing Address
First Line	:	1390 E PLACITA MAPACHE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-3929
Country	:	US
Telephone Number	:	520-243-0518
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 N ORACLE RD STE 101
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-3850
Country	:	US
Telephone Number	:	520-243-0518
Fax Number	:

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

Provider Enumeration Date	:	07/29/2009
Last Update Date	:	08/10/2021

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