Doctor Name: | MR. GUSTAVO J. MEDOSKY |
NPI Number: | 1578752549 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.M.T. |
License Number: | MA19949 |
Business Practice Address: | 1912 S University Dr B4 Davie, FL - 333245849 |
Business Phone Number: | 9545360767 |
Business Fax Number: | |
Mailing Address: | 6681 Sw 20th St, PLANTATION |
State: | FL |
Postal Code: | 333175104 |
Phone Number: | 9545360767 |
Fax Number: | |
NPI Enumeration Date: | 10/16/2007 |
NPI Last Update Date: | 03/21/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA19949 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |