Provider Demographics
NPI:1902174709
Name:DELGARRO PHYSICAL THERAPY CENTER, CORP.
Entity Type:Organization
Organization Name:DELGARRO PHYSICAL THERAPY CENTER, CORP.
Other - Org Name:MASSAGE ESTABLISHMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARROTE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:786-712-7096
Mailing Address - Street 1:8040 NW 95TH ST APT 228
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2361
Mailing Address - Country:US
Mailing Address - Phone:305-819-1095
Mailing Address - Fax:305-819-1094
Practice Address - Street 1:8040 NW 95TH ST APT 228
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2361
Practice Address - Country:US
Practice Address - Phone:305-819-1095
Practice Address - Fax:305-819-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62214225700000X
FLMM28078261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty