Provider Demographics
NPI:1225624117
Name:MAGNA PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MAGNA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:305-776-2084
Mailing Address - Street 1:7419 BIG CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2506
Mailing Address - Country:US
Mailing Address - Phone:305-776-2084
Mailing Address - Fax:
Practice Address - Street 1:7419 BIG CYPRESS DR
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2506
Practice Address - Country:US
Practice Address - Phone:305-776-2084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy