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General NPI Number Information
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NPI Number | 1831563493
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Entity Type | Organization
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Legal Business Name | CENTER FOR RADIANT HEALTH
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 7800 SW 57TH AVENUE SUITE 330D
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5544
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Country | US
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Telephone | 305-667-1918
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Fax | 305-667-1912
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Provider Business Mailing Address
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Address Line | 7800 SW 57TH AVENUE SUITE 330D
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5544
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Country | US
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Telephone | 305-667-1918
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Fax | 305-667-1912
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KAREN L. GORDON
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Credential | A.P., P.T.
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Telephone | 305-667-1918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT3466
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP370
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License Number State | FL
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