MEDICARE: GARY H DIBLASIO M D P A

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	208100000X	Physical Medicine & Rehabilitation Physician	ME74052	FL

General Provider Information

NPI Number	:	1538473053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY H DIBLASIO M D P A

Provider Business Mailing Address
First Line	:	5500 VILLAGE BLVD
Second Line	:	STE 101
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1961
Country	:	US
Telephone Number	:	561-684-6565
Fax Number	:	561-684-3467

Provider Business Practice Location Address
First Line	:	5500 VILLAGE BLVD
Second Line	:	STE 101
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1961
Country	:	US
Telephone Number	:	561-684-6565
Fax Number	:	561-684-3467

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	GARY HENRY DIBLASIO
Credential	:	M.D.
Telephone Number	:	561-684-6565

Provider Enumeration Date	:	07/27/2010
Last Update Date	:	07/28/2010

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