Healthcare Provider Details

I. General information

NPI: 1740478098
Provider Name (Legal Business Name): DOROTHY GIPSON CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N KROME AVE
HOMESTEAD FL
33030-4460
US

IV. Provider business mailing address

335 S KROME AVE
FLORIDA CITY FL
33034-4906
US

V. Phone/Fax

Practice location:
  • Phone: 305-242-8122
  • Fax:
Mailing address:
  • Phone: 305-242-8122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT1679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: