| Organization Name: | ED MEDICAL THERAPY CENTER, INC. |
| NPI Number: | 1790060333 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JANIS GOMEZ (PRESIDENT) |
| Mailing Address: | 4311 W Waters Ave Suit #205 Tampa |
| State: | FL US |
| Postal Code: | 33614 |
| Phone Number: | 8134071591 |
| Fax Number: | |
| NPI Enumeration Date: | 10/14/2011 |
| NPI Last Update Date: | 05/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | HCC9274 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FM |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |