=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285137471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GABLES THERAPY & WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2018
-----------------------------------------------------
Last Update Date | 12/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 MADEIRA AVE
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-4516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-342-4270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 MADEIRA AVE
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-4516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-342-4270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JORGE E VINALS
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 305-342-4270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT22557
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------