Provider Demographics
NPI:1093015471
Name:DR CLAUDIUS GALEN THERAPY CENTER,INC
Entity Type:Organization
Organization Name:DR CLAUDIUS GALEN THERAPY CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:786-662-9188
Mailing Address - Street 1:489 HIALEAH DR STE 10
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5320
Mailing Address - Country:US
Mailing Address - Phone:786-953-6302
Mailing Address - Fax:786-953-6664
Practice Address - Street 1:489 HIALEAH DR STE 10
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5320
Practice Address - Country:US
Practice Address - Phone:786-953-6302
Practice Address - Fax:786-953-6664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 13096174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001958200Medicaid
FL1700042595OtherNATIONAL PROVIDER IDENTIFIER( NPI)
FL002900800Medicaid