Provider Demographics
NPI:1336440718
Name:YANG, GU (LMT)
Entity Type:Individual
Prefix:
First Name:GU
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14115 S DIXIE HWY
Mailing Address - Street 2:SUITE I
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7256
Mailing Address - Country:US
Mailing Address - Phone:786-282-8733
Mailing Address - Fax:786-573-0553
Practice Address - Street 1:14115 S DIXIE HWY
Practice Address - Street 2:SUITE I
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7256
Practice Address - Country:US
Practice Address - Phone:786-282-8733
Practice Address - Fax:786-573-0553
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38370225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist