Active NPI
Gallardo De Grano Hermoso, PT
- Physical Therapist
- Lake Placid, FL
National Provider Identifier
1407057904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 23151
- Practice address
- 125 Tomoka Blvd S
Lake Placid, FL 33852-8123 - Phone
- (863) 465-7200
- NPI assigned
- May 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 23151 | FL | Primary |
Addresses
Primary practice location
125 Tomoka Blvd S
Lake Placid, FL 33852-8123
Mailing address
837 Lincoln Rd NE
Lake Placid, FL 33852-3482
Phone (863) 202-5263
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 23151 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407057904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "837 LINCOLN RD NE",
"city": "LAKE PLACID",
"state": "FL",
"postal_code": "338523482",
"telephone_number": "863-202-5263"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 TOMOKA BLVD S",
"city": "LAKE PLACID",
"state": "FL",
"postal_code": "338528123",
"telephone_number": "863-465-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERMOSO",
"first_name": "GALLARDO",
"middle_name": "DE GRANO",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT 23151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Placid, FL
- Heartland Pediatrics of Lake Placid, Inc.
- Heartland Pharmacy Lake Placid (Heartland Pharmacy)
- Heartland Pharmacy Lake Placid Inc
- Heartland Pharmacy Lake Placid Inc (Heartland Pharmacy, LTC)
- Michael James Henry, DO
- Lydeliz Hernandez Perez
- Milagros Socooro Hernandez
- Nancy High, MD
- Highlands Elder Care, Inc.
- Highlands Sunshine Services
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.