Provider Demographics
NPI:1821405978
Name:GSJ PHYSICAL REHAB LLC.
Entity Type:Organization
Organization Name:GSJ PHYSICAL REHAB LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPT
Authorized Official - Prefix:MR
Authorized Official - First Name:GODFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:305-603-8613
Mailing Address - Street 1:420 NE 55TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-2617
Mailing Address - Country:US
Mailing Address - Phone:305-603-8613
Mailing Address - Fax:305-603-8613
Practice Address - Street 1:420 NE 55TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2617
Practice Address - Country:US
Practice Address - Phone:305-603-8613
Practice Address - Fax:305-603-8613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002776600Medicaid