Provider Demographics
NPI:1922556307
Name:GYASI AZPEITIA, OTR/L, P.A.
Entity Type:Organization
Organization Name:GYASI AZPEITIA, OTR/L, P.A.
Other - Org Name:LIV ACTIVE THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GYASI
Authorized Official - Middle Name:
Authorized Official - Last Name:AZPEITIA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:786-332-2672
Mailing Address - Street 1:10610 SW 148TH AVENUE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-2453
Mailing Address - Country:US
Mailing Address - Phone:786-346-6841
Mailing Address - Fax:
Practice Address - Street 1:9495 SW 72ND ST # B120
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3253
Practice Address - Country:US
Practice Address - Phone:786-332-2672
Practice Address - Fax:786-369-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11017174400000X, 261QM1300X, 261QR0400X
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025097100Medicaid
FL1144332420OtherNPPES