Organization
MAGNOLIA PEDIATRIC THERAPY
Active
Organization
MAGNOLIA PEDIATRIC THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY GAUNT (SUPERVISOR)
(678) 571-0033
Entity
Organization
Contact information
Practice address
340 W 23RD ST, SUITE H, PANAMA CITY, FL 32405-7600
(850) 215-3911
(850) 215-3914
Mailing address
340 W 23RD ST, SUITE H, PANAMA CITY, FL 32405-7600
(850) 215-3911
(850) 215-3914
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
SZ4644
FL
Other
Enumeration date
09/03/2009
Last updated
09/03/2009
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