=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265756084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASSAGEWORKS PHYSICAL THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2010
-----------------------------------------------------
Last Update Date | 10/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 SAINT CHARLES PL APT 817
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33026-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-934-2514
-----------------------------------------------------
Fax | 954-432-9665
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 SAINT CHARLES PL APT 817
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33026-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-934-2514
-----------------------------------------------------
Fax | 954-432-9665
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. GILBERTO V RAMIREZ
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 305-934-2514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------