Provider Demographics
NPI:1912006032
Name:GENTLE CARE PT, CORP
Entity Type:Organization
Organization Name:GENTLE CARE PT, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIESCO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:305-323-5833
Mailing Address - Street 1:13601 SW 78TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3203
Mailing Address - Country:US
Mailing Address - Phone:305-323-5833
Mailing Address - Fax:305-387-9332
Practice Address - Street 1:13601 SW 78TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3203
Practice Address - Country:US
Practice Address - Phone:305-323-5833
Practice Address - Fax:305-387-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8894Medicare ID - Type Unspecified