Provider Demographics
NPI:1245774322
Name:GTD MEDICAL & REHABILITATION CENTER, INC
Entity type:Organization
Organization Name:GTD MEDICAL & REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KESNEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THEUS
Authorized Official - Suffix:
Authorized Official - Credentials:D,O,M
Authorized Official - Phone:561-557-2138
Mailing Address - Street 1:1195 N MILITARY TRL STE 5B
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6058
Mailing Address - Country:US
Mailing Address - Phone:561-557-2138
Mailing Address - Fax:
Practice Address - Street 1:1195 N MILITARY TRL STE 5B
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6058
Practice Address - Country:US
Practice Address - Phone:561-557-2138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2382171100000X
FLME43064208D00000X
FL2293171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty