1407311467 NPI number — MRS. GORGETTE WAHIB DOZE I PHYSICAL THERAPIST

Table of content: MRS. GORGETTE WAHIB DOZE I PHYSICAL THERAPIST (NPI 1407311467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407311467 NPI number — MRS. GORGETTE WAHIB DOZE I PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOZE
Provider First Name:
GORGETTE
Provider Middle Name:
WAHIB
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
I
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407311467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11903 68TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33773-3510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-421-7038
Provider Business Mailing Address Fax Number:
727-587-0059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11903 68TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33773-3510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-421-7038
Provider Business Practice Location Address Fax Number:
727-587-0059
Provider Enumeration Date:
02/04/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  10632 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FIZ376192311465 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com