MEDICARE: DERLY MUNOZ PT

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	PT8988	FL

General Provider Information

NPI Number	:	1821071572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERLY MUNOZ PT

Provider Business Mailing Address
First Line	:	5188 NW 58TH ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32653-4102
Country	:	US
Telephone Number	:	352-376-3082
Fax Number	:	352-376-3082

Provider Business Practice Location Address
First Line	:	4343 W NEWBERRY RD
Second Line	:	SUITE 4
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-2817
Country	:	US
Telephone Number	:	352-373-7984
Fax Number	:	352-332-3812

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	12/16/2013

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Directions to “ DERLY MUNOZ PT” Practice Location

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