Individual
GUSTAVO MAGNOLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
19930 NE 21ST AVE, MIAMI, FL 33179-2822
(305) 409-2213
Mailing address
19930 NE 21ST AVE, MIAMI, FL 33179-2822
(305) 409-2213
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA14895
FL
Other
Enumeration date
01/12/2012
Last updated
01/12/2012
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