MEDICARE: GAITWAY THERAPY L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	224Z00000X	Occupational Therapy Assistant	FL
2	225200000X	Physical Therapy Assistant
3	225X00000X	Occupational Therapist	FL
4	225100000X	Physical Therapist	FL

General Provider Information

NPI Number	:	1265924039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAITWAY THERAPY L.L.C.

Provider Business Mailing Address
First Line	:	961 PLOVER AVE
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-4346
Country	:	US
Telephone Number	:	305-213-7192
Fax Number	:

Provider Business Practice Location Address
First Line	:	961 PLOVER AVE
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-4346
Country	:	US
Telephone Number	:	305-213-7192
Fax Number	:

Authorized Official
Title or Position	:	PTA
Name	:	MELISSA ROSES-RODRIGUEZ
Credential	:	PTA
Telephone Number	:	305-213-7192

Provider Enumeration Date	:	06/06/2018
Last Update Date	:	06/06/2018

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Directions to “GAITWAY THERAPY L.L.C. ” Practice Location

Language	Start Address	Practice Location

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