MEDICARE: ETERNITY THERAPEUTICS CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1114797081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETERNITY THERAPEUTICS CORP

Provider Business Mailing Address
First Line	:	6215 SW 59TH ST
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-2105
Country	:	US
Telephone Number	:	305-799-9344
Fax Number	:

Provider Business Practice Location Address
First Line	:	6215 SW 59TH ST
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-2105
Country	:	US
Telephone Number	:	305-799-9344
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL PINTO
Credential	:
Telephone Number	:	305-799-9344

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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Directions to “ETERNITY THERAPEUTICS CORP ” Practice Location

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