Provider Demographics
NPI:1225110661
Name:DADE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:DADE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT, OCS
Authorized Official - Phone:305-661-1441
Mailing Address - Street 1:8603 S DIXIE HWY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7807
Mailing Address - Country:US
Mailing Address - Phone:305-661-1441
Mailing Address - Fax:305-661-1443
Practice Address - Street 1:8603 S DIXIE HWY
Practice Address - Street 2:SUITE 308
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7807
Practice Address - Country:US
Practice Address - Phone:305-661-1441
Practice Address - Fax:305-661-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 5204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1225110661OtherNPI