Healthcare Provider Details

I. General information

NPI: 1467362400
Provider Name (Legal Business Name): SHAPING HEART THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7911 NW 72ND AVE STE 202B
MEDLEY FL
33166-2223
US

IV. Provider business mailing address

7911 NW 72ND AVE STE 202B
MEDLEY FL
33166-2223
US

V. Phone/Fax

Practice location:
  • Phone: 813-900-3934
  • Fax:
Mailing address:
  • Phone: 813-900-3934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: REINIER GONZALEZ
Title or Position: PRESIDENT
Credential:
Phone: 813-900-3934