Provider Demographics
NPI:1235435843
Name:MARTIN, GREMYS
Entity Type:Individual
Prefix:
First Name:GREMYS
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 W FLAGLER ST
Mailing Address - Street 2:SUITE 506
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1586
Mailing Address - Country:US
Mailing Address - Phone:305-446-7898
Mailing Address - Fax:
Practice Address - Street 1:4265 NW SOUTH TAMIAMI CANAL DR
Practice Address - Street 2:APT. 115
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1481
Practice Address - Country:US
Practice Address - Phone:786-715-6753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 61626225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAC# 237878OtherSTATE OF FL DEPT. OF HEALTH DIVISION OF MEDIACAL QUALITY ASSURANCE