MEDICARE: GOLDEN THERAPY CENTER, INC.

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	261Q00000X	Clinic/Center	HCC4276	FL

General Provider Information

NPI Number	:	1134237738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN THERAPY CENTER, INC.

Provider Business Mailing Address
First Line	:	3750 W 16TH AVE STE 226U
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4648
Country	:	US
Telephone Number	:	305-826-9796
Fax Number	:	305-826-9779

Provider Business Practice Location Address
First Line	:	3750 W 16TH AVE STE 226U
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4648
Country	:	US
Telephone Number	:	305-826-9796
Fax Number	:	305-826-9779

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. HEIDY MARTINEZ
Credential	:	M.T
Telephone Number	:	305-826-9796

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	08/20/2012

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