NPIMap

Organization Active NPI

Magnolia Pediatric Therapy

  • Speech-Language Pathologist
  • Panama City, FL
National Provider Identifier
1952533002
Registry record updated Aug 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SA2869 Issued in FL
Legal business name
MAGNOLIA PEDIATRIC THERAPY
Practice address
340 W 23Rd St
Suite H
Panama City, FL 32405-7600
Phone
(850) 215-3911
Fax
(850) 215-3914
NPI assigned
Aug 21, 2009
Last updated
Aug 21, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2009

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

Authorized official

Name
Gary Gault
Title
Owner
Phone
(678) 571-0033

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SA2869 FL Primary

Addresses

Primary practice location

340 W 23Rd St
Suite H
Panama City, FL 32405-7600

Mailing address

340 W 23Rd St
Suite H
Panama City, FL 32405-7600
Phone (850) 215-3911

National Provider Directory

National Provider Directory
Tax ID family
Magnolia Rehab Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1250812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250812800000",
    "number": "1952533002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 W 23RD ST",
            "address_2": "SUITE H",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324057600",
            "telephone_number": "850-215-3911",
            "fax_number": "850-215-3914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 W 23RD ST",
            "address_2": "SUITE H",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324057600",
            "telephone_number": "850-215-3911",
            "fax_number": "850-215-3914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA PEDIATRIC THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-21",
        "last_updated": "2009-08-21",
        "status": "A",
        "authorized_official_last_name": "GAULT",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-571-0033"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA2869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2009; 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.