Provider Demographics
NPI:1831563493
Name:CENTER FOR RADIANT HEALTH
Entity type:Organization
Organization Name:CENTER FOR RADIANT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:AP, PT
Authorized Official - Phone:305-667-1918
Mailing Address - Street 1:7800 SW 57TH AVENUE
Mailing Address - Street 2:SUITE 330D
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5544
Mailing Address - Country:US
Mailing Address - Phone:305-667-1918
Mailing Address - Fax:305-667-1912
Practice Address - Street 1:7800 SW 57TH AVENUE
Practice Address - Street 2:SUITE 330D
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5544
Practice Address - Country:US
Practice Address - Phone:305-667-1918
Practice Address - Fax:305-667-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3466225100000X
FLAP370171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty