1033444013 NPI number — MS. COURTNEY'S THERAPY SERVICES, LLC

Table of content: (NPI 1033444013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033444013 NPI number — MS. COURTNEY'S THERAPY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MS. COURTNEY'S THERAPY SERVICES, LLC
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:
CONNECTIONS THERAPY 4 KIDS
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:
1033444013
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2833 EXECUTIVE PARK DR
Provider Second Line Business Mailing Address:
300
Provider Business Mailing Address City Name:
WESTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33331-3650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-353-8777
Provider Business Mailing Address Fax Number:
954-389-1990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2833 EXECUTIVE PARK DR
Provider Second Line Business Practice Location Address:
#202
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33331-3650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-353-8777
Provider Business Practice Location Address Fax Number:
954-389-1990
Provider Enumeration Date:
10/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
COURTNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CLINICAL DIRECTOR
Authorized Official Telephone Number:
954-353-8777

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  OT 9973 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0200X , with the licence number: OT 13120 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: OT 11230 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: OT 12777 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA 9092 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001491200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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