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General NPI Number Information
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NPI Number | 1710256532
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Entity Type | Organization
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Legal Business Name | VILLACIAN THERAPHY CENTER, INC
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Dates
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Enumeration Date | 12/22/2011
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 7171 SW 24TH ST STE 419
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City | MIAMI
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State | FL
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Zip | 33155-1693
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Country | US
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Telephone | 305-262-1004
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Fax | 305-262-1005
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Provider Business Mailing Address
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Address Line | 7171 SW 24TH ST STE 419
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City | MIAMI
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State | FL
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Zip | 33155-1693
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Country | US
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Telephone | 305-262-1004
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Fax | 305-262-1005
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Authorized Official
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Title or Position | PRESIDENT
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Name | GABRIEL GONZALEZ
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Credential | LMT
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Telephone | 305-262-1004
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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 | HCC9364
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License Number State | FL
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