Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT5888 | FL |
N | 2251G0304X | Physical Therapist - Geriatrics | PT5888 | FL |
NPI | 1326086885 |
---|---|
Provider Name | Mary Angelie Alcala Garay Gibbs |
First Address | Clermont, FL 34711-3164 |
Second Address | Clermont, FL 34711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 14/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4398900 | (05) | FL |