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General NPI Number Information
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NPI Number | 1366147514
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Entity Type | Organization
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Legal Business Name | POWERMAG THERAPY CORP
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Dates
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Enumeration Date | 04/04/2023
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 3750 W COLONIAL DR # 2
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City | ORLANDO
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State | FL
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Zip | 32808-7906
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Country | US
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Telephone | 407-480-2175
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Fax |
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Provider Business Mailing Address
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Address Line | 3750 W COLONIAL DR # 2
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City | ORLANDO
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State | FL
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Zip | 32808-7906
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Country | US
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Telephone | 407-480-2175
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. VANDERLEI GONCALVES
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Credential |
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Telephone | 407-509-0784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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