MEDICARE: MR. GABRIEL CARVAJAL JR. MPT

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	225100000X	Physical Therapist	PT20822	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407059868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GABRIEL CARVAJAL JR. MPT

Provider Business Mailing Address
First Line	:	9431 SW 54TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-6415
Country	:	US
Telephone Number	:	305-905-4188
Fax Number	:	305-595-1055

Provider Business Practice Location Address
First Line	:	6812 SW 81ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33143-7708
Country	:	US
Telephone Number	:	305-768-9134
Fax Number	:	786-338-7421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	10/03/2024

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