Healthcare Provider Details

I. General information

NPI: 1831563493
Provider Name (Legal Business Name): CENTER FOR RADIANT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SW 57TH AVENUE SUITE 330D
SOUTH MIAMI FL
33143-5544
US

IV. Provider business mailing address

7800 SW 57TH AVENUE SUITE 330D
SOUTH MIAMI FL
33143-5544
US

V. Phone/Fax

Practice location:
  • Phone: 305-667-1918
  • Fax: 305-667-1912
Mailing address:
  • Phone: 305-667-1918
  • Fax: 305-667-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP370
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3466
License Number StateFL

VIII. Authorized Official

Name: MS. KAREN L. GORDON
Title or Position: PRESIDENT
Credential: A.P., P.T.
Phone: 305-667-1918