MEDICARE: DIMENSIONS PHYSICAL THERAPY AND WELLNESS

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	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29586	OTHER	FL	PT

General Provider Information

NPI Number	:	1801366521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIMENSIONS PHYSICAL THERAPY AND WELLNESS

Provider Business Mailing Address
First Line	:	6010 AMBASSADOR DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3436
Country	:	US
Telephone Number	:	228-623-7411
Fax Number	:

Provider Business Practice Location Address
First Line	:	6010 AMBASSADOR DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3436
Country	:	US
Telephone Number	:	228-623-7411
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VERLENCIA WALKER-GONER
Credential	:	P.T.
Telephone Number	:	228-623-7411

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	11/26/2018

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Directions to “DIMENSIONS PHYSICAL THERAPY AND WELLNESS ” Practice Location

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