Individual
GERELLA MATHEOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ITDS
Contact information
Practice address
13101 BRUCE B DOWNS BLVD, TAMPA, FL 33612-3803
(813) 974-2201
Mailing address
PO BOX 917770, ORLANDO, FL 32891
(813) 974-0602
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
247200000X
Other Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014728000
—
FL
Enumeration date
02/26/2015
Last updated
03/21/2019
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