MEDICARE: MAIRA RAMIREZ GOMEZ PT

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	PT27613	FL

General Provider Information

NPI Number	:	1568711364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIRA RAMIREZ GOMEZ PT

Provider Business Mailing Address
First Line	:	5862 NW 48TH CT
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5862 NW 48TH CT
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2135
Country	:	US
Telephone Number	:	561-305-3859
Fax Number	:

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

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	09/07/2012

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