Provider Demographics
NPI:1427235522
Name:SUAREZ, GARY NEIL VITERBO (DPT, PT)
Entity type:Individual
Prefix:MR
First Name:GARY NEIL
Middle Name:VITERBO
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1020 W AVENIDA DEL RIO
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-0225
Mailing Address - Country:US
Mailing Address - Phone:863-983-9979
Mailing Address - Fax:863-983-5655
Practice Address - Street 1:501 E SUGARLAND HWY
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3210
Practice Address - Country:US
Practice Address - Phone:863-983-9979
Practice Address - Fax:863-983-5655
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT21918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI942ZMedicare PIN