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General NPI Number Information
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NPI Number | 1083256168
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Entity Type | Organization
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Legal Business Name | GLUTALITY PROVIDER GROUP, P.A.
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 5300 BROKEN SOUND BLVD NW STE 200
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City | BOCA RATON
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State | FL
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Zip | 33487-3514
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Country | US
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Telephone | 561-678-2026
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Fax | 561-423-9249
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Provider Business Mailing Address
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Address Line | 5300 BROKEN SOUND BLVD NW STE 200
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City | BOCA RATON
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State | FL
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Zip | 33487-3514
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Country | US
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Telephone | 561-678-2026
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN M SORTINO
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Credential |
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Telephone | 561-596-7517
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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