Basic Information
| Provider Information | |||||||||
| NPI: | 1033245287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAJO | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | PANCHO | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10395 NARCOOSSEE RD E | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328326939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077303244 | ||||||||
| FaxNumber: | 4077303246 | ||||||||
| Practice Location | |||||||||
| Address1: | 3303 S SEMORAN BLVD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328222500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072810228 | ||||||||
| FaxNumber: | 4072810229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2007 | ||||||||
| LastUpdateDate: | 08/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT18613 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.