Provider Demographics
NPI:1386930527
Name:LLUCH FITZPATRICK, GLORIA (PTA)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:LLUCH FITZPATRICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15699 SW 54TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5618
Mailing Address - Country:US
Mailing Address - Phone:954-558-8461
Mailing Address - Fax:305-569-0267
Practice Address - Street 1:15699 SW 54TH CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5618
Practice Address - Country:US
Practice Address - Phone:954-558-8461
Practice Address - Fax:305-569-0267
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA9071225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant