Doctor Name: | GALLARDO DE GRANO HERMOSO |
NPI Number: | 1407057904 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | PT 23151 |
Business Practice Address: | 125 Tomoka Blvd S Lake Placid, FL - 338528123 |
Business Phone Number: | 8634657200 |
Business Fax Number: | |
Mailing Address: | 837 Lincoln Rd Ne, LAKE PLACID |
State: | FL |
Postal Code: | 338523482 |
Phone Number: | 8632025263 |
Fax Number: | |
NPI Enumeration Date: | 05/30/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | PT 23151 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |