Provider Demographics
NPI:1154516318
Name:BANEZ, GEMMA MANUEL (PT)
Entity type:Individual
Prefix:
First Name:GEMMA
Middle Name:MANUEL
Last Name:BANEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7775 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2536
Mailing Address - Country:US
Mailing Address - Phone:561-967-6800
Mailing Address - Fax:561-967-0975
Practice Address - Street 1:7775 LAKE WORTH RD STE A
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2519
Practice Address - Country:US
Practice Address - Phone:561-855-6170
Practice Address - Fax:561-855-6167
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT011092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6447ZMedicare PIN