Provider Demographics
NPI:1467782136
Name:UNIVERSE THERAPY CENTER, INC
Entity Type:Organization
Organization Name:UNIVERSE THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:786-464-1943
Mailing Address - Street 1:8181 NW 36TH ST
Mailing Address - Street 2:SUITE 30
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6671
Mailing Address - Country:US
Mailing Address - Phone:786-464-1943
Mailing Address - Fax:786-464-1945
Practice Address - Street 1:8181 NW 36TH ST
Practice Address - Street 2:SUITE 30
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6671
Practice Address - Country:US
Practice Address - Phone:786-464-1943
Practice Address - Fax:786-464-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-02
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM 23862261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy