Basic Information
| Provider Information | |||||||||
| NPI: | 1770942328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAYNOR | ||||||||
| FirstName: | SARAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4971 LE CHALET BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334361418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617626866 | ||||||||
| FaxNumber: | 5617400714 | ||||||||
| Practice Location | |||||||||
| Address1: | 1037 S STATE ROAD 7 | ||||||||
| Address2: | 111 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334146138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617367006 | ||||||||
| FaxNumber: | 5618287710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2016 | ||||||||
| LastUpdateDate: | 02/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT31160 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.