MEDICARE: GALE MARIE PHILSON

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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1871145490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALE MARIE PHILSON

Provider Business Mailing Address
First Line	:	3804 E HANNA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-3759
Country	:	US
Telephone Number	:	813-495-4997
Fax Number	:	866-214-4347

Provider Business Practice Location Address
First Line	:	3804 E HANNA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-3759
Country	:	US
Telephone Number	:	813-495-4997
Fax Number	:	866-214-4347

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

Provider Enumeration Date	:	07/13/2019
Last Update Date	:	07/13/2019

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Directions to “ GALE MARIE PHILSON ” Practice Location

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