Provider Demographics
NPI:1194946806
Name:BTW PROVIDERS, LLC
Entity type:Organization
Organization Name:BTW PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:786-507-1600
Mailing Address - Street 1:8080 NW 155TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5880
Mailing Address - Country:US
Mailing Address - Phone:786-507-1600
Mailing Address - Fax:786-507-1610
Practice Address - Street 1:8080 NW 155TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5880
Practice Address - Country:US
Practice Address - Phone:786-507-1600
Practice Address - Fax:786-507-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7163208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty