Healthcare Provider Details

I. General information

NPI: 1770086357
Provider Name (Legal Business Name): EAST COAST RESPIRATORY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 WILEY ST
HOLLYWOOD FL
33020-6523
US

IV. Provider business mailing address

1528 WILEY ST
HOLLYWOOD FL
33020-6523
US

V. Phone/Fax

Practice location:
  • Phone: 954-297-4545
  • Fax:
Mailing address:
  • Phone: 954-297-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRT13901
License Number StateFL

VIII. Authorized Official

Name: DIANA GIRALDO
Title or Position: PRESIDENT
Credential:
Phone: 954-297-4545