Provider Demographics
NPI:1720560071
Name:GLF MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:GLF MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASAGE TERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAIMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORROTO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:786-203-6531
Mailing Address - Street 1:8500 W FLAGLER ST STE 106A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2063
Mailing Address - Country:US
Mailing Address - Phone:786-203-6531
Mailing Address - Fax:
Practice Address - Street 1:8500 W FLAGLER ST STE 106A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2063
Practice Address - Country:US
Practice Address - Phone:786-203-6531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty