Organization
THE GULFSIDE GROUP, LLC
Active
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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