Basic Information
Provider Information
NPI: 1144486689
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GEDNEY
FirstName: RITA
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2699
Address2:  
City: PENSACOLA
State: FL
PostalCode: 325132699
CountryCode: US
TelephoneNumber: 8504754500
FaxNumber: 8504754619
Practice Location
Address1: 4406 N DAVIS HWY
Address2:  
City: PENSACOLA
State: FL
PostalCode: 325032756
CountryCode: US
TelephoneNumber: 8504341570
FaxNumber: 8504343342
Other Information
ProviderEnumerationDate: 08/04/2008
LastUpdateDate: 08/04/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT18467FLY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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