Organization
THE GULFSIDE GROUP, LLC
Active
Other names
Kidz Rx
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE PORTOGHESE OT (OCCUPATIONAL THERAPIST)
(727) 389-1339
Entity
Organization
Contact information
Practice address
711 CRYSTAL LAKE RD, LUTZ, FL 33548-6431
(727) 389-1339
Mailing address
711 CRYSTAL LAKE RD, LUTZ, FL 33548-6431
(727) 389-1339
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Enumeration date
08/14/2020
Last updated
09/03/2020
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