| NPI | 1952644221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL D GILMORE President/Owner 850-398-8480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XX0005X Orthopaedic Surgery Sports Medicine |
| 2080S0010X Pediatrics Sports Medicine | |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine | |
| 225100000X Physical Therapist | |
| 2251X0800X Physical Therapist Orthopedic | |
| 225200000X Physical Therapy Assistant | |
| 363A00000X Physician Assistant | |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2018-12-06 |