Provider Demographics
NPI:1972726750
Name:GOROBETZ, PETER (LMT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:GOROBETZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 N COURSE DR
Mailing Address - Street 2:APT. # 203
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3368
Mailing Address - Country:US
Mailing Address - Phone:954-551-1446
Mailing Address - Fax:
Practice Address - Street 1:75 E PROSPECT RD
Practice Address - Street 2:SUITE 4B
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-1400
Practice Address - Country:US
Practice Address - Phone:954-551-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43276225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist