Provider Demographics
NPI:1043580160
Name:G & G REHABILITATION CENTER CORP.
Entity Type:Organization
Organization Name:G & G REHABILITATION CENTER CORP.
Other - Org Name:G & G REHABILITATION CENTER CORP.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MASSAGE THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-363-9981
Mailing Address - Street 1:2460 SW 137TH AVE STE 244
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6399
Mailing Address - Country:US
Mailing Address - Phone:786-363-9981
Mailing Address - Fax:
Practice Address - Street 1:2460 SW 137TH AVE STE 244
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6399
Practice Address - Country:US
Practice Address - Phone:786-363-9981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:G & G REHABILITATION CENTER CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty