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General NPI Number Information
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NPI Number | 1659719821
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Entity Type | Organization
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Legal Business Name | AG THERAPEUTIC SERVICES, CORP
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 11380 SW 113TH TER
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City | MIAMI
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State | FL
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Zip | 33176-3829
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Country | US
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Telephone | 786-426-7570
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Fax | 305-742-2753
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Provider Business Mailing Address
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Address Line | 11380 SW 113TH TER
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City | MIAMI
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State | FL
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Zip | 33176-3829
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Country | US
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Telephone | 786-426-7570
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Fax | 305-742-2753
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ANGELA BIBIANA GONZALEZ
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 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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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 20342
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License Number State | FL
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