Individual provider · NPI-1

Jorge Gavilla, PTA

Physical Therapy Assistant · Doral, FL

NPI number1801373634
StatusActive
Last updated in NPPESJul 24, 2018

Details

NPI
1801373634
Entity type
Individual (NPI-1)
Name
Jorge Gavilla
Credential
PTA
Sex
Male
Sole proprietor
No
Enumeration date
Jul 24, 2018
Last updated
Jul 24, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225200000X Physical Therapy Assistant28361FLYes

Practice location

2600 Nw 87th Ave Ste 22
Doral, FL 33172-1619

Phone 305-592-5555 · Fax 305-592-6067

Mailing address

1285 W 76th St
Hialeah, FL 33014-3422

Phone 786-230-6296

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