Provider Demographics
NPI:1124332390
Name:SEIFERT, GILBERT WAYNE JR (PTA)
Entity type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:WAYNE
Last Name:SEIFERT
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:675 BINNEY ST NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3118
Mailing Address - Country:US
Mailing Address - Phone:321-951-9657
Mailing Address - Fax:321-951-9657
Practice Address - Street 1:675 BINNEY ST NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3118
Practice Address - Country:US
Practice Address - Phone:321-951-9657
Practice Address - Fax:321-951-9657
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPTA22217225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant