Provider Demographics
NPI:1184998544
Name:UNIVERSAL THERAPEUTICS INC
Entity type:Organization
Organization Name:UNIVERSAL THERAPEUTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:305-870-0091
Mailing Address - Street 1:6501 NW 36TH ST STE 411
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6964
Mailing Address - Country:US
Mailing Address - Phone:305-870-0091
Mailing Address - Fax:
Practice Address - Street 1:6501 NW 36TH ST STE 411
Practice Address - Street 2:
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6964
Practice Address - Country:US
Practice Address - Phone:305-870-0091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM26999273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit