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General NPI Number Information
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NPI Number | 1356834337
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Entity Type | Organization
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Legal Business Name | AG SPECIAL THERAPY SERVICES CORP
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 12670 SW 93 PLACE
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City | MIAMI
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State | FL
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Zip | 33176
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Country | US
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Telephone | 786-426-7570
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Fax |
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Provider Business Mailing Address
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Address Line | 12670 SW 93RD PL
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City | MIAMI
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State | FL
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Zip | 33176-5041
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Country | US
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Telephone | 786-426-7570
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MRS. ANGELA BIBIANA GNOZALEZ
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Credential | PT
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Telephone | 786-426-7570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT20342
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License Number State | FL
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