Provider Demographics
NPI:1417140948
Name:GOLD COAST THERAPY
Entity Type:Organization
Organization Name:GOLD COAST THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:MASSE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:954-288-8667
Mailing Address - Street 1:9213 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5222
Mailing Address - Country:US
Mailing Address - Phone:954-288-8667
Mailing Address - Fax:
Practice Address - Street 1:9213 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5222
Practice Address - Country:US
Practice Address - Phone:954-288-8667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty