Provider Demographics
NPI:1194093591
Name:URRACA, GLADYS HILDA JR (MSPT)
Entity type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:HILDA
Last Name:URRACA
Suffix:JR
Gender:F
Credentials:MSPT
Other - Prefix:MRS
Other - First Name:GLADYS
Other - Middle Name:HILDA
Other - Last Name:ULLOA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:18444 SW 87TH CT
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7226
Mailing Address - Country:US
Mailing Address - Phone:305-281-0742
Mailing Address - Fax:
Practice Address - Street 1:18444 SW 87TH CT
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7226
Practice Address - Country:US
Practice Address - Phone:305-281-0742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 23339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist