Provider Demographics
NPI:1326298738
Name:GOMIDES, ELAINE SOUZA (MSPT)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:SOUZA
Last Name:GOMIDES
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6486 NW 80TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2485
Mailing Address - Country:US
Mailing Address - Phone:954-871-1307
Mailing Address - Fax:
Practice Address - Street 1:6486 NW 80TH DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-2485
Practice Address - Country:US
Practice Address - Phone:954-871-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0260722251P0200X
NJ40QA011153002251P0200X
FLPT28315222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics