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General NPI Number Information
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NPI Number | 1467782136
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Entity Type | Organization
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Legal Business Name | UNIVERSE THERAPY CENTER, INC
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Dates
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Enumeration Date | 01/02/2010
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Last Update Date | 01/02/2010
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Provider Practice Location Address
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Address Line | 8181 NW 36TH ST SUITE 30
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City | DORAL
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State | FL
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Zip | 33166-6671
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Country | US
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Telephone | 786-464-1943
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Fax | 786-464-1945
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Provider Business Mailing Address
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Address Line | 8181 NW 36TH ST SUITE 30
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City | DORAL
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State | FL
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Zip | 33166-6671
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Country | US
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Telephone | 786-464-1943
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Fax | 786-464-1945
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANUEL G GONZALEZ
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Credential | LMT
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Telephone | 786-464-1943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | MM 23862
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License Number State | FL
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