| Organization Name: | MAGNOLIA REHAB SERVICES |
| NPI Number: | 1235457052 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY GAULT (OWNER) |
| Mailing Address: | 1775 Lewis Turner Blvd Suite 101 Fort Walton Beach |
| State: | FL US |
| Postal Code: | 325476640 |
| Phone Number: | 8502268279 |
| Fax Number: | 8502268326 |
| NPI Enumeration Date: | 05/05/2010 |
| NPI Last Update Date: | 05/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SA 7938 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |