Gary Roy Paben, M.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT18600 Issued in FL

Practice address

12497 Tamiami TRL S
Suite 12
North Port, FL 34287-1447

Phone

(941) 426-3934

Fax

(941) 426-6718

NPI assigned

Jul 2, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Greene Rehab Services PA

  • Rehabilitation Clinic/Center
  • Venice, FL
  • NPI 1831192970
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1689603698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11441 DANCING RIVER DR",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342924127",
            "telephone_number": "941-493-6979",
            "fax_number": "941-484-5487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12497 TAMIAMI TRL S",
            "address_2": "SUITE 12",
            "city": "NORTH PORT",
            "state": "FL",
            "postal_code": "342871447",
            "telephone_number": "941-426-3934",
            "fax_number": "941-426-6718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PABEN",
        "first_name": "GARY",
        "middle_name": "ROY",
        "name_prefix": "Mr.",
        "credential": "M.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-02",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT18600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Y85581",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jane F Paino, MD
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• Dominic Paredes
• Stacie Paroda

• Physical Therapist in North Port, FL
• Providers in North Port, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.

Verify at the official NPI Registry.