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General NPI Number Information
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NPI Number | 1780462986
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Entity Type | Individual
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Provider Name | MR. GARY DENESTAN
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Gender | Male
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 7200 W COMMERCIAL BLVD SUITE 203
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City | LAUDERHILL
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State | FL
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Zip | 33319-2148
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Country | US
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Telephone | 954-526-3518
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Fax |
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Provider Business Mailing Address
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Address Line | 7030 NW 40TH CT
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-2212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA71654
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License Number State | FL
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