Most Relevant Information
Provider Data
| NPI Number: | 1003467291 |
| Provider Name: | BRYCE GIMMARRO LAT, ATC |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | AL6014 |
Most Important Dates
| Enumeration Date: | 09/27/2019 |
| Last Updated: | 08/04/2020 |
Provider Practice Location
290 WOODLAWN DR
GAINESVILLE
FL
326111949
Practice Location Phone/Fax
| Phone: | 7346648861 |
| Fax: |
Provider Mailing Location
1680 HARTER WAY
THE VILLAGES
FL
321635318
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |