Provider Demographics
NPI:1053898668
Name:GOTAY, MARIA IRENE (LMT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:IRENE
Last Name:GOTAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 BONITA BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-3214
Mailing Address - Country:US
Mailing Address - Phone:303-250-7386
Mailing Address - Fax:
Practice Address - Street 1:515 36TH ST W STE D
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-2459
Practice Address - Country:US
Practice Address - Phone:941-745-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA90529225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist