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General NPI Number Information
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NPI Number | 1659697985
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Entity Type | Organization
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Legal Business Name | GNC THERAPIES
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 04/12/2010
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Provider Practice Location Address
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Address Line | 5489 WILES RD SUITE #304
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4220
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Country | US
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Telephone | 954-984-2701
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Fax | 954-984-1873
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Provider Business Mailing Address
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Address Line | 5489 WILES RD SUITE #304
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City | COCONUT CREEK
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State | FL
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Zip | 33073-4220
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Country | US
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Telephone | 954-984-2701
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Fax | 954-984-1873
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Authorized Official
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Title or Position | OWNER
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Name | MR. OCTAVIO LIMA
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Credential |
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Telephone | 954-548-1159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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