1346579430 NPI number — PEDIATRIC THERAPY ASSOCIATES OF SOUTH FLORIDA, INC.

Table of content: (NPI 1346579430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346579430 NPI number — PEDIATRIC THERAPY ASSOCIATES OF SOUTH FLORIDA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC THERAPY ASSOCIATES OF SOUTH FLORIDA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PEDIATRIC THERAPY ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346579430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
447 NW 73RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33317-1608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-583-7383
Provider Business Mailing Address Fax Number:
954-583-7388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
447 NW 73RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33317-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-583-7383
Provider Business Practice Location Address Fax Number:
954-583-7388
Provider Enumeration Date:
12/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WOJCIK
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR/ OWNER
Authorized Official Telephone Number:
954-583-7383

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001696000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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