Healthcare Provider Details

I. General information

NPI: 1255310181
Provider Name (Legal Business Name): GAITWAY REHABILITATION AND FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12001 SW 128TH CT STE 104
MIAMI FL
33186-4664
US

IV. Provider business mailing address

12001 SW 128TH CT STE 104
MIAMI FL
33186-4664
US

V. Phone/Fax

Practice location:
  • Phone: 305-234-2320
  • Fax: 305-234-2344
Mailing address:
  • Phone: 305-234-2320
  • Fax: 305-234-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALDO RUIZ
Title or Position: PRESIDENT
Credential:
Phone: 305-234-2320