Provider Demographics
NPI:1194511758
Name:GLC THERAPY PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GLC THERAPY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARYROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:GULAPA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:239-352-9884
Mailing Address - Street 1:5263 GOLDEN GATE PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7601
Mailing Address - Country:US
Mailing Address - Phone:239-352-9884
Mailing Address - Fax:239-228-3291
Practice Address - Street 1:5263 GOLDEN GATE PKWY STE E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7601
Practice Address - Country:US
Practice Address - Phone:239-352-9884
Practice Address - Fax:239-228-3291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLC THERAPY PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891617900Medicaid