Provider Demographics
NPI:1447365523
Name:GWIN, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:GWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8905 SW 87TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2227
Mailing Address - Country:US
Mailing Address - Phone:305-661-3000
Mailing Address - Fax:305-661-3054
Practice Address - Street 1:8905 SW 87TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2227
Practice Address - Country:US
Practice Address - Phone:305-661-3000
Practice Address - Fax:305-661-3054
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL965OtherLICENSE #