Provider Demographics
NPI:1760897318
Name:GUAL, CARLOS JOSE (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:JOSE
Last Name:GUAL
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12805 PEGASUS DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32816-2205
Mailing Address - Country:US
Mailing Address - Phone:407-823-1407
Mailing Address - Fax:
Practice Address - Street 1:12805 PEGASUS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-2205
Practice Address - Country:US
Practice Address - Phone:407-823-1407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 37312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer