Provider Demographics
NPI:1790111847
Name:GRAS, GIOMAR F (PTA)
Entity Type:Individual
Prefix:MR
First Name:GIOMAR
Middle Name:F
Last Name:GRAS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 SW 133RD AVENUE RD APT 321
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5328
Mailing Address - Country:US
Mailing Address - Phone:786-663-3020
Mailing Address - Fax:
Practice Address - Street 1:1140 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3323
Practice Address - Country:US
Practice Address - Phone:305-558-1203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA24397225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant