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NPI Code Detail

MEDICARE: ANDREA GAINEY PTA

MEDICARE: ANDREA GAINEY 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
1225200000XPhysical Therapy AssistantPTA17320FL

General Provider Information

NPI Number : 1548368442
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA GAINEY PTA
Provider Business Mailing Address
First Line : 252 SE JEREMY PL
Second Line :
City : LAKE CITY
State : FL
Zip : 32025-3900
Country : US
Telephone Number : 386-754-2142
Fax Number :
Provider Business Practice Location Address
First Line : 540 KINGSLEY AVE
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-4847
Country : US
Telephone Number : 904-264-2156
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 07/08/2007

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