MEDICARE: MURIEL EMILCE GONZALEZ GRANDOLI MPT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	32389	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538691324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MURIEL EMILCE GONZALEZ GRANDOLI MPT

Provider Business Mailing Address
First Line	:	6773 S WATERWAY DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-3743
Country	:	US
Telephone Number	:	786-901-1236
Fax Number	:	786-364-0217

Provider Business Practice Location Address
First Line	:	5200 SW 8TH ST STE 202B
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2337
Country	:	US
Telephone Number	:	786-901-1236
Fax Number	:	786-364-0217

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	08/07/2019

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