Provider Demographics
NPI:1255310181
Name:GAITWAY REHABILITATION AND FITNESS
Entity Type:Organization
Organization Name:GAITWAY REHABILITATION AND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-234-2320
Mailing Address - Street 1:12001 SW 128TH CT
Mailing Address - Street 2:STE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4664
Mailing Address - Country:US
Mailing Address - Phone:305-234-2320
Mailing Address - Fax:305-234-2344
Practice Address - Street 1:12001 SW 128TH CT
Practice Address - Street 2:STE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4664
Practice Address - Country:US
Practice Address - Phone:305-234-2320
Practice Address - Fax:305-234-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4044OtherMEDICARE LEGACY
FLDO9845Medicare PIN
K4044Medicare PIN